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REPORT  OF  THE 

UNITED  STATES  INTERDEPARTMENTAL 
SOCIAL  HYGIENE  BOARD 

FOR  THE  FISCAL  YEAR  ENDING  JUNE  30 

1920 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1920 


7\  C  x^l 


5  L 


UNITED    STATES    INTERDEPARTMENTAL    SOCIAL    HYGIENE    BOARD. 


Members. 


David  F.  Houston,  ^ 

Secretary  of  the  Treasury. 
Newton  D.  Baker, 

Secretary  of  War. 
JosEPHus  Daniels, 

Secretary  of  the  Navy. 


Col.  P.  M.  ASHBUEN,  ^ 

Medical  Corps,  United  States  Army. 
Lieut.  Commander  J.  R.  Phelps, 

Medical  Corijs,  United  States  Navy, 
Asst.  Surg.  Gen.  C.  C.  Piekce, 

United  States  Puhlic  Health  Service. 


Officers. 


Josephus  Daniels,  Chairman  of  the  Board, 
Secretary  of  the  Navy. 

Executive  Committee. 

Asst.  Surg.  Gen.  C.  C.  Pierce,  U.  S.  P.  H.   S,,  Chairman. 

Col.  P.  M.  AsHBURN,  ^  M.  C,  U.  S.  A. 

Lieut.  Commander  J.  R.  Phelps,  M.  C,  U.  S.  N. 

Executive  Secretary. 

T.  A.  Storey,  M.  D.,  Ph.  D. 

1  Hon.  David  F.  Houston  succeeded  Hon.  Carter  Glass  Feb.  2,  1920,  who  succeeded  Hon. 
William  G.  McAdoo  Dec.  16,  1918.  The  Secretary  has  been  represented  throughout  this 
period  by  Hon.  J.  H.  Moyle,  Assistant  Secretary. 

"  Col.  P.  M.  Ashburn  succeeded  Lieut.  Col.  William  F.  Snow  Oct.  3,  1919.  During  Col. 
Snow's  absence  in  Europe  he  was  represented  by  Maj.  Wilbur  A.  Sawyer  and  Col.  F.  F. 
Russell,  Dee.  20,  1919  to  June  4,  1920.  Col.  Weston  P.  Chamberlain  will  succeed  Col. 
P.  M.  Ashburn  July  6,  1920. 


TABLE  OP^  CONTENTS. 


Page. 
Lettei-  of  submittal 9 

Part  I. 

Genenil  discussion  of  tlie  work  of  the  Unit-^J  Stater.  Intcrdepuilinental 

Social  Hygiene  Board  for  the  year  enclec!  Jtiiie  30,  1920 11 

A.  Discussion  of  year's  work 11 

B.  Summary  of  accomplishment^: . 21 

1.  Appropriation  for  the  care  of  civilian  persons,  etc 21 

2.  Appropriation   for  allotment  to   States  for  the  prevention, 

treatment,  and  control  of  venereal  diseasss 23 

*  H.  Appropri.ition  for  the  puipose  of  discovering  more  effective 

medical    mensnres    in    tlie   prevention    and    treatment    of 

venereal  diseases 23 

4.  Appropriation  for  the  purpose  of  discovering  and  developing 
more  effective  educational  measures  in  the  prevention  of 
venereal  diseases  and  for  the  puriiose  of  soqiologic  and 
psychologic  research  related  thereto 24 

Paet  II. 

Report  on  the  activities  of  the  several  divisions  under  the  United  States 

InteiTlepartmental  Social  Hygiene  Board . 26 

A.  Charts  of  appropi'iations,  functions  and  personnel 26 

B,  Eeport  on  the  division  of  relations  with  States 42 

1.  Report  on  protective  social  measures 42 

fl.  Appropriation  .and  congressional  authorization 42 

&.  Social-measures  program'  of  the  United  States  Inter- 
departmental Social  Hygiene  Board  for  the  protec- 
tion of  soldiers  and  sailors  from  venereal  disease 42 

c.  Tabulation  showing  program  of  assignment  of  bureaus 

of  protective  social  measures  on  June  30,  1920 47 

(1)  States  to  which  bureaus  of  protective  social 

measures  have  been  assigned 47 

(2)  States  in  which  assignment  is  in  process 47 

(3)  States  in  which  plans  for  bureaus  have  not 

yet  been  perfected 47 

(4)  States  in  which  because  of  their  present  lim- 

ited naval  and  nrilitary  population  no 
attempt  has  been  made  to  establish  bureaus_  47 
a.  Tabulation  by  States  showing  location  of  Army  and 
Navy  complements,  known  localities  from  which  ve- 
nereal infections  have  been  received  by  soldiers  and 
the  distribution  of  agents  of  the  board  for  the  appli- 
cation of  protective  social  measures  as  of  June 
20,  1920 4g 

8 


4  CONTENTS. 

Page. 
Report  on  the  activities  of  the  several  divisions  under  tlie  United  States 

Interdepartmental  Social  Hygiene  Board — Continued. 

B.  Report  on  the  division  of  relations  with  States — Continued. 

1.  Report  on  protective  social  measures^Continued. 

e.  Report  of  case  work  with  women  and  girls  by  the 

field  service 77 

Table  1. — Number  of  cases,  fiscal  year  1919-20__  77 
Table  2.— Color  of  new  cases,  fiscal  year  1919-20-  77 
Table   3. — Men  involved  in  new  cases,  fiscal  year 

1919-20 77 

Table   4.- — Sex  relations  of  new  cases,  January  to 

June,  1920 77 

Table   5. — Source  of  complaint  of  new  cases,  fis- 

^      .  cal  year  1919-20 . 78 

Table   6. — Reason  for  complaining  of  new  cases, 

fiscal  year  1919-20 79 

Table   7. — Disposition  of  new  cases,   fiscal  year 

1919-20 ^     80 

Table   8. — Disposition  of  continued  and  reopened 

eases,  fiscal  year  1919-20 81 

Table  9.— Total  disposition,  fiscal  year  1919-20—  82 
Table  10.— Special  data,  fiscal  year  1919-20 83 

f.  Red-light  districts  and  their  relationship  to  the  Army 

and  Navy 84 

g.  Case  histories:  Examples  of  cases  that  come  under 

the  influence  of  the  protective  social  measures  field 

service  of  the  board 84 

7i.  Geographic  distribution  of  the  sources  of  infection  of 
10,000  soldiers  reporting  to  the  Surgeon  General  of 

the  Army 90 

i.  Analysis  of  the  nine  consolidated  reports  of  individual 
venereal  disease  reports,  Nos.  1  to  10,000,  submitted 
in  compliance  with  Surgeon  General's  Office  Cir- 
cular Letter  No.  293,  between  September  10,  1919, 

and  September  13,  1920 91 

j.  Records  for  13  years  of  venereal  diseases  in  the  Army_        92 
7c.  Venereal  diseases  in   the  Army  for  the  fiscal  year 

ending  June  30,  1920 94 

I.  Venereal   diseases   in   the  Navy   for  the  fiscal  year 

ending  June  30,  1920 94 

m.  Reports  received  from  field  representatives 94 

n.  Reports  of  supervisors  and  field  agents  (men) 94 

o.  Reports  of  confidential  agents  (men  and  women) 95 

p.  Record  of  law  enforcement  stimulated  by  evidence 
submitted  to  law-enforcing  agencies  through  repre- 
sentatives of  the  board 95 

q.  Committees  formed 95 

r.  Tabulation  showing  red-light  districts  which  were 
closed  through  the  assistance  of  the  board's  field 
representatives,  giving  the  number  of  houses  and 

inmates  thereof 95 

-s.  Tabulation  of  certain  observations  made  by  protective 
social  agents  of  the  board  in  their  search  for  the 
foci  of  venereal  disease  from  November  1,  1919 
to  June  30.  1920 ,„. . 96 


CONTENTS.  0 

Pace. 

Report  on  the  activities  of  the  several  divisions  under  tlie  United  States 

Interdepartmental  Social  Hygiene  Board — Continued. 

B.  Report  on  the  division  of  relations  with  States — Continued. 

1.  Report  on  protective  social  measures — Continued. 

t.  Tabulations  show^ing  red-light  districts  discovered  by 
the  board's  agents  which  remained  open  on  June 
30,  1920 97 

2.  Program  for  assistance  of  States  in  maintaining  civilian 

persons  whose  detention,  isolation,  quarantine,  or  commit- 
ment to  institutions  has  been  foimd  necessary  for  the  pro- 
tection of  the  military  and  naval  forces  of  the  United 
States  against  venereal  diseases 97 

a.  General    regulations   governing   appropriations    from 

the  United  States  Interdepartmental  Social  Hygiene 
Board  for  assistance  of  institutions  in  the  mainte- 
nance of  venereally  infected  patients 97 

b.  Summary 98 

3.  Report  on  medical  measures 99 

a.  Regulations  and  administration 99 

&.  Statement  summarizing  the  program  made  this  year 
by  the  Division  of  Venereal  Diseases  of  the  United 
States  Public  Health  Service  in  cooperation  with 
the  United  States  Interdepartmental  Social  Hygiene 
Board,  applying  the  program  promulgated  by  the 
Secretary  of  the  Treasury  and  supported  by  the 
Federal  allotments  to  States  through  the  United 
States  Interdepartmental  Social  Hygiene  Board,  for 
the  prevention,  treatment,  and  control  of  venereal 
diseases  through  State  departments  of  health 100 

(1)  Medical   measures 100 

(a)  Reporting 100 

(&)  Treatment 101 

(c)   Clinics 102 

(2)  Law  enforcement 104 

(3)  Educational  105 

(4)  Conclusion   105 

C.  Report  on  the  Division  of  Scientific  Research 106 

1.  Classification   and   description   of  the  scientific   researches 

that  are  being  assisted  by  the  United  States  Interdepart- 
mental Social  Hygiene  Board 106 

a.  Chancroids 106 

6.  Gonorrhea  107 

c.  Syphilis 115 

2.  Data  on  scieiitific  research  fund 128 

a.  Table 128 

b.  Summary . 128 

D.  Report  on  the  Division   of  Educational  Research  and   Develop- 

ment        128 

1.  Principles  and  regulations . 128 

2.  Applications  for  assistance  from  the  educational  research 

and  development  fund  :  Number,  purpose,  and  disposition.      130 

3.  Allotments:    Number,   amount,   purpose,   distribution,    and 

relevant  facts 132 

4.  Administrative  relations  between  the  board  and  cooperating 

d(  pardnents  of  hygiene 136 


b  CONTENTS. 

Report  on  the  activities  of  the  several  divisions  under  the  United  States 
Interdepartmental  Social  Hygiene  Board — Continued. 

D.  Report  on  the  Division  of  Educational  Research  and  Develop- 

ment— Continued. 

5.  Administration  of  the  educational   research   and  develop- 

ment fund 138 

6.  Progress     in     effective    organization    of.    departments    of 

hygiene 139 

7.  Extent  to  v^rhick  the  program,  of  instruction  and  training  in 

hygiene  has  been  put  into  effect 141 

8.  Progress  in  developing  better  educational  methods 146 

9.  Indirect  infliience  through  departments  of  hygiene 149 

10.  Researches:  Sociological  and  psychological 1,51 

E.  Report  on  the  business  office 154 

1.  J'inancial  summary,  fiscal  year  ended  June  30,  1920 155 

2.  Detail  of  expenditures  from  appropriation  (a) 1.55 

["  Interdepartmental     Social     Hygiene     Board,     1920," 
$100,000.] 

3.  Detail  of  expenditures  from  appropriation  (h) 1.56 

["Aid  to  States,  etc.,"  $784,000.] 

4.  Statement  of  payments  to  detention  houses,  etc 1.56 

5.  Detail  of  expenditures  from  appropriation  (c) 1,56 

["Payments  to  States,"  $1,087,831.42.] 

6.  Detail  of  expenditures  from  appropriation   (cl) 1,57 

["  Payments  to  universities,  etc.,  for  research  in  educa- 
tional measures,"  $439,030.] 

7.  Detail  of  expenditures  from  appropriation  (e) 1.58 

["Payments  to  universities,  etc.,  research  venereal  dis- 
eases," $103,430.] 

Part  III. 

Extracts  covering  activities  for  the  year  ending  .June  30,  1919,  taken 
from'  the  manual  for  the  various  agents  of  the  United  States  Interde- 
partmental Social  Hygiene  Board 1.59 

A.  Introduction 1.59 

1.  Background  and  purposes  of  law  creating  the  boards 1.59 

2.  Summary  of  the  work  of  the  board  for  the  period  ending 

June  30,  1919 161 

B.  Period  of  organization 165 

1.  Period  of  interpretation 166 

2.  Proposed  amendments  and  their  fate 168 

3.  Period  of  incomplete  administrative  organization 168 

C.  Activities 170 

1.  Civilian  quarantine  and  isolation  fund 170 

a.  Program    for    assistance    of    States    in    building    re- 

formatories        170 

b.  Program  for  assistance  of  States  in  maintaining  vene- 

real disease  patients 173 

c.  Program   of   protective    social    ureasures — Service    of 

women  agents 174 

d.  Program   of  protective   social   measures — Service    of 

men  agents I'J^S 

2.  Scientific  research  fund 182 

3.  Educational  research  and  development  fund 185 

4.  United  States  Public  Health  Service  venereal  disease  fuud__  189 


(-•ONTKNTS.  i 

l'AX{T  IV.  Page. 

Appendices 193 

Special  appendix :  Cost  of  venereal  disease — 
Estimates  of  costs  of  venereal  diseases  in — 

1.  The  United  States  Array 193 

2.  The  State  of  Massachusetts  (selected  group) 194 

3.  The  St.  Louis-Southwestern  Railway  lines 195 

4.  England 196 

Appendix  A 197 

1.  Federal  law  under  which  the  Interdepartmental   Social  Hy- 

giene Board  operates :  An  act  making  appropriations  for  the 

support  of  the  Army  for  the  fiscal  year  ending  June  30,  1919_  197 

2.  Amendments  to  law 199 

a.  Reappropriations  for  the  year  ending  June  30,  l&^iO : 

An  act  making  appropriations  for  sundry  civil  ex- 
penses of  the  Government  for  the  fiscal  year  ending 

June  30,  1920,  and  for  other  purposes 199 

b.  Extensions  of  duties  and  powers  and  appropriations  for 

the  fiscal  year  ending  June  30,  1921:  Section  of  the 

sundry  civil  act  for  fiscal  year  ending  June  -30,  1921__  199 

Appendix  B 201 

1.  Regulations  for  assistance  of  institutions  in  the  maintenance 

of  venereally  infected  patients 201 

2.  Form    of    request    for    maintenance    of    venereally    infected 

patients 201 

Appendix   C 203 

1.  Functions  of  the  protective  social  measures  staff 203 

2.  Form  of  proposal  for  governmental  assistance  in  the  organiza- 

tion of  bureaus  of  protective  social  measures  in  State  de- 
partments of  health 211 

Appendix  D . 214 

Rules  and  regulations  governing  expenditures  of  the  State  allot- 
ments from  the  Chamberlain-Kahn  funds 214 

1.  Appropriations 214 

2.  Regulations 215 

3.  Allotments,  percentage,  population 218 

4.  Population  of  continental  United  States,  census  of  1910 218 

5.  Unexpended  balances,  1919-20 218 

6.  Board's  regulations  regarding  payment  of  balances 219 

7.  State  certificates 219 

8.  Joint  State  and  Federal  budgets 220 

9.  Sample  joint  State  and  Federal  budget 220 

10.  Revised  joint  State  and  Federal  budget 221 

11.  The  50-50  plan 221 

12.  Payment 222 

13.  Uniform  accounting 222 

14.  Voucher  form 222 

15.  Clinics 224 

16.  Obtaining  signatures  to  vouchers 224 

17.  Books,  periodicals,  and  automobiles 225 

18.  Classification  of  expenditures 225 


8  CONTENTS. 

Appendices — Continued.  Page 
Appendix  D — Continued. 

Rules  and  regulations  governing  expenditures  of  tlie  State  allot- 
ments from  the  Chamberlain-Katm  funds — Continued. 

19.  Quarterly  statement  of  budget  balances 226 

20.  Disposition  of  vouchers 226 

21.  Monthly  reports 227 

22.  Summary  recorded  on  monthly  reports 227 

23.  State  laws 227 

24.  Conclusion 228 

Appendix  E 229 

1.  Regulations  governing  the  scientific  research  fund 229 

2.  Application  form  for  assistance  in  scientific  research 230 

Appendix  F 232 

1.  Regulations  governing  the  educational  research  and  develop- 

ment fund 232 

2.  Application  form  for  assistance  in  the  establishment  or  en- 

largement of  departments  of  hygiene  in  normal  schools,  col- 
leges, and  universities 239 

Appendix  G- 245 

1.  Regulations  governing  payments  to  State  universities  for  the 

establishment  of  divisions  of  educational  hygiene  in  State 

departments  of  education 245 

2.  Form  letter  of  agreement  with   State  universities  to  assign 

administrative   personnel   to    State   departments   of   public 

education 245 

Appendix  H 248 

Publications  on  hand  June  30,  1920 . 248 

1.  General  and  miscellaneous 248 

2.  Protective  social  and  medical  measures 248 

3.  Educational  research  and  development 248 

4.  Scientific   researches 249 


LETTER  OF  SUBMITTAL. 
\  

United  States  Interdepartmental 
Social  Hygiene  Board, 
Washington,  D.  C,  October  14,  1920. 
Gentlemen  : 

In  accordance  with  the  act  of  July  1,  1902,  I  have  the  honor  to 
submit  herewith  for  transmittal  to  Congress  the  Annual  Report  of' 
the  Interdepartmental  Social  Hygiene  Board  for  the  fiscal  year- 
ending  June  30,  1920. 

Respectfully, 

T.  A.  Storey, 

Executive  Secretary 

Interdepartmental  Social  Hygiene  Board. 

To  the  United  States  Interdepartmental  Social  Hygiene  Board.. 

9 


♦* 


ANNUAL  REPORT  OF  THE  INTERDEPARTMENTAL  SOCIAL  HYGIENE 

BOARD,  1920. 


Paet  I. 


General  Discussion  of  the  Work  of  the  United  Slates  Inlerdepaitmental  Social  Hygiene  Board 
for  the  Year  Ending  June  30,  1920. 


DISCUSSION  OF  YEAR'S  WORK. 

The  startling  frequenej'  and  universal  distribution  of  the  venereal 
diseases,  the  type  and  habits  of  their  human  carriers,  the  useless 
waste  of  human  vigor,  human  productivity,  and  human  life  which 
they  inflict  upon  the  people  of  the  nation,  and  the  proven  possibility 
•of  their  practical  control,  are  powerful  national  arguments  that 
wholly  and  completely  justify  the  program  of  the  United  States 
Government  for  the  assistance  of  its  constituent  State  governments  in 
the  control  and  eradication  of  these  diseases. 

We  find  that  during  the  fiscal  year  ending  June  30, 1920,  there  were 
14,000  cases  of  venereal  disease  reported  in  the  Army,  21,000  cases 
reported  in  the  Navy,  and  326,000  cases  (men,  women,  and  children) 
reported  to  State  boards  of  health  from  the  civilian  population.  The 
probabilities  are  that  the  total  number  of  these  cases  in  the  civilian 
population  of  the  continental  TTnited  States  during  this  period  was 
very  considerably  in  excess  of  the  number  reported  to  State  commis- 
sioners of  health.  Kather  conservative  estimates  made  by  the  Ameri- 
can Social  Hygiene  Association  place  this  number  in  the  civilian 
population  at  1,106,000  men  and  420,000  women. ^ 

And  we  know  from  observations  m.ade  in  all  parts  of  the  world 
covering  a  great  number  of  years  that  these  diseases  are  commonly 
associated  with  crime,  Avith  shame,  and  with  wrecked  lives  and 
ruined  homes,  with  misery,  pain,  and  unhappiness.  These  facts  give 
tragic  emphasis  to  the  national  importance  of  the  1,500,000  cases 
estimated  for  the  civilian  population  of  this  past  year.  The  financial, 
social,  and  biologic  damages  from  these  diseases  must  be  enormous. 

1  While  these  figures  are  not  stiitistlcally  accurate,  they  are  believed  to  be  approxi- 
mately correct. 

11 


12       REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

An  estimated  wage  loss  of  more  than  $69,000,000  a  year,  an  estimated 
minimum  cost  to  the  Government  of  $15,000,000  in  the  Army,  for 
the  calendar  year  1919,  a  contribution  of  more  babies  made  blind  and 
more  men  and  women  made  sterile  by  gonorrhea  than  by  any  other 
cause,  and  a  record  of  more  cases  of  insanity  from  syphilis  than  from 
any  other  one  cause,  are  a  few  of  the  items  in  the  economic,  social, 
and  biologic  bookkeeping  of  syphilis,  gonorrhea,  and  chancroid  that 
-would  lead  to  a  staggering  ledger  account  if  such  items  could  be 
posted. 

We  know  the  causes  of  these  diseases  and  we  know  their  carriers. 
We  know  that  each  of  the  three  venereal  diseases— syphilis,  gonor- 
rhea, and  chancroid — is  caused  by  a  specific  organism  (a  germ)  and 
that  this  organism  in  each  case  is  the  cause  of  no  other  disease.  We 
know  that  the  human  is  the  only  animal  that  under  ordinary  circum- 
stances is  infected  with  these  diseases.  We  know  that  every  case  i& 
the  result  of  a  transfer  of  living  germs  from  a  person  infected  to 
-another  person  who  is  not,  and  we  know  that  the  transmission  of  these 
diseases  is  in  the  vast  majority  of  cases  associated  with  sexual  inter- 
course between  diseased  and  undiseased  persons. 

The  common  and  most  effective  disseminator  of  gonorrhea,  syphi- 
lis, and  chancroid  is  the  prostitute.  But  the  man  and  the  woman  of 
loose  morals  and  promiscuous  sex  habits  are  factors  of  almost  equal! 
importance  in  the  spread  of  these  diseases.^  If  there  were  any  ques- 
tion on  these  facts,  it  v/ould  be  settled  by  reference  to  Col.  Ashburn's 
Studies  on  Venereal  Diseases  in  the  Army,  or  by  reference  to  our  own 
analysis  of  15,000  cases  of  delinquent  women  and  girls.  These  dis- 
ease carriers  are  commonly  persons  who  are  not  attached  perma- 
nently to  one  locality.  They  travel  from  place  to  place.  Therefore 
the  woman  that  gives  herself  promiscuously  and  the  loose  man  that 
brings  disaster  to  the  innocent— often  his  own  wife  and  babies — are 
national  liabilities.  Consequently  the  control  of  prostitution  is  a 
joint  problem  involving  a  community.  State,  and  national  obligation. 
The  enormous  number  of  citizens  involved,  the  huge  financial^ 
economic,  and  social  losses  sustained,  the  irreparable  damage  done  to 
man  power  and  woman  power  and  to  the  infant  and  child  life  of  the 
Nation,  and  the  fact  that  not  a  community,  not  a  village,  and  not  a 
city  in  the  Nation  escapes  are  additional  records  that  establish  the 
protective,  preventive,  and  remedial  hygiene  of  these  diseases  as  joint 
•  obligations  of  the  State  and  the  Nation. 

Our  scientific  knowledge  of  the  living  causes,  the  human  carriers, 
and  the  method  of  dissemination  of  these  diseases  places  us  in  posi- 
tion to  lay  out  plans  for  their  successful  treatment,  prevention,  con- 
trol, and  possible  eradication. 

1  There  are  now  10  States  with  legislation  that  defines  prostitution  as  an  act  of  the 
male  as  well  as  of  the  female. 


REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD.       13 

The  following  report  furnished  by  the  Surgeon  General  of  the 
Army  emphasizes  the  several  very  important  factors  that  must  l^e 
included  in  a  successful  program  for  the  control  of  these  diseases 
and  brings  clearly  into  view  some  of  the  educational,  informational, 
economic,  social,  and  medical  difficulties  involved,  and  gives  a  vivid 
picture  of  legal  and  institutional  inadequacies  and  limitations  that 
must  be  surmounted : 

.[Extract  from   a   report  of  a   sanitary   inspection   of   Camp   E ■ made   by    Col. 

H ,  Medical  Corps,  June  5-6,  1920.] 

G.  Statistics  of  sickness  : 

******* 

Tile  venereal  i-ate  at  this  post  is  excessive.  Men  who  conti-acc  venei'eal  dis- 
ease are  usually  infected  by  AA-onien  or  girls  who  v\'ork  in  the  mills,  and  50  per 
tent  of  the  men  are  said  to  pay  nothing  to  these  women  for  their  association. 

The  present  city  ordinance,  city  of  C ,  authorizes  the  health  officer 

to  segregate  those  who  have  venereal  disease,  and  C has  appropriated 

•$41,000  to  build  a  detention  hospital  for  these  people.  An  active  venereal  clinic 
is  maintained  by  the  healtli  officer.  More  than  200  active  venereal  cases 
are  now  being  treated  at  this  clinic,  one  full-time  doctor  and  one  nurse 
being  employed.     All  the  girls  and  women  who  come  to  this  clinic  are  sent 

by  Miss  W ,  field  agent,  Interdepartmental  Social  Hygiene  Board. 

If  they  do  not  appear,  when  she  tells  them  to  do  so,  they  are  arrested,  fined, 
and  then  placed  in  the  so-called  stockade  which  is  used  temporarily  as  a  deten- 
tion hospital.  As  a  rule,  she  gets  her  information  concerning  the  girls  from 
medical  officers  at  the  camp  who  interrogate  soldiers  and  secure  the  names  of 

the  individuals  who  infected  them.     Miss  W stated  to  the  inspector 

that  the  information  thus  secured  from  soldiers  had  always  been  accurate, 
and  she  had  always  been  able  to  get  the  female  in  question  under  treatment, 
or  else  have  her  placed  in  the  stockade.  The  stockade  in  which  these  Avomen 
at  present  are  detained,  if  they  do  not  appear  daily  for  treatment  as  directed, 
is  not  an  attractive  place,  and  Miss  W states  that  she  has  little  dif- 
ficulty in  getting  them  under  treatment  for  the  reason  that  they  fear  the  stock- 
ade. Six  women  were  in  the  stockade  on  the  date  of  inspection.  When  the 
detention  home  is  built  that  is  now  authorized  space  will  be  available  to  accom- 
modate 50  women.  In  the  absence  of  adequate  detention  space  infected  Avomen 
may  go  home  and  report  daily  for  treatment.  "If  they  fail  to  report  daily  they 
are  arrested  and  placed  in  the  stockade.  This  stockade  is  merely  the  city  jail, 
but  the  infected  women  have  freedom  of  the  back  yard,  Avhich  constitutes  the 
stockade. 

When  these  girls  are  cured  an  effort  is  made  to  remove  them  from  their  old 

environment,  68  having  been  sent  out  by  Miss  W ,  who  has  secured 

positions  for  them  at  other  points,  with  the  hope  that  the  change  might  prove 

of  benefit.    Most  of  the  girls  handled  by  Miss  W are  from  13  to  17. 

A  great  many  are  infected  at  an  early  age.     Miss  W now  has  one 

family  of  four  children,  all  infected  with  gonorrhea.  The  oldest  child  is  14  and 
the  youngest  7.  She  is  also  working  upon  another  family  of  three  children,  a 
boy  14,  a  girl  9,  and  a  brother  7,  all  of  whom  have  gonorrhea,  and  the  mother  and 
father  are  also  infected.  In  this  case  a  16-year  old  prostitute  was  living  in 
the  house  with  the  family.  The  father  contracted  gonorrhea  from  this  youthful 
prostitute,  as  did  also  the  14-year  old  boy  and  the  7-year  old  child,  all  through 
direct  sexual  intercourse.  The  9-year  old  girl  contracted  it  in  a  manner  not 
known.    In  another  instance  the  whole  family  has  syphilis.    In  another  family, 


14        REPORT  U,  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

a  girl  13  and  a  boy  9  have  gonorrhea,  and  when  the  father  was  informed  of 
their  condition,  he  replied,  "  Of  course  they  have  venereal  disease." 

A  good  many  of  the  professional  prostitutes  are  said  by  Miss  W to 

be  13  years  old,  and  she  knows  of  one  case  in  a  little  girl  of  11.  This  latter 
child  is  now  at  the  juvenile  court  and  an  endeavor  is  being  made  to  place  her  in 

some  suitable  institution.     Miss  W sent  off  a  child  aged  12  on  the 

day  of  inspection  who  was  a  professional.     She  w;is  placed  in  the  G ■ 

Training  School  for  Girls. 

Miss  W states  that  this  is  the  worst  place  in  this  State.     If  it 

isn't,  the  morals  of  are  not  to  be  commended.     The  commanding. 

officer  of  Camp  B ,  the  camp  surgeon,  the  morale  officer,  the  prison, 

officer,  and  all  city  authorities  are  lending  every  aid  to  Miss  W — in, 

this  work. 

The  United  States  Interdepartmental  Social  H3'giene  Board  iS; 
now  completing  an  analysis  of  carefully  compiled  case  histories  of- 
15,000  delinquent  girls  and  women  whose  lives  are  more  or  less  t^^'pi- 

fied  in  the  communication  quoted  above  from  Col.  H ■ — . 

These  15,000  cases  demonstrate  with  a  tragic  emphasis  the  importance, 
of  education,  information,  protection,  and  medical  and  social  treat- 
ment in  the  control  of  these  diseases.  They  disclose  sex  discrimina- 
tion and  utterly  inadequate  penal,  detention  house,  and  reformatory 
provisions.  These  analyses  associated  with  the  experiences  and  con-, 
elusions  of  other  individuals  and  agencies  concerned  with  the  con- 
trol and  eradication  of  these  communicable  diseases,  and  added  to. 
the  lessons  learned  under  the  stress  of  the  Great  War,  have  led  to 
the  formulation  of  a  much  more  nearly  complete  program  for  the. 
protection  of  the  individual,  the  home,  and  the  community. 

Briefly,  the  control  of  gonorrhea,  syphilis,  and  chancroid  depends 
upon  the  effective  operation  of  a  composite  program  of  hygiene, 
considered  in  its  broadest  sense.     Each  factor  in  this  program  is. 
essential  to  the  success  of  the  program  as  a  whole.     The  main  fac- 
tors in  the  hygiene  of  the  venereal  diseases  are : 

(1)  The  educational  hygiene  of  infancy,  childhood,  and  youth. 
Moral,  mental,  and  physical  education  of  the  young  human,  giving 
him  the  character  basis  on  which  he  will  form  safe  judgments  and 
develop  wise  conduct. 

(2)  The  informational  hygiene  of  childhood,  youth,  and  maturity, 
supplying  scientific  facts  and  rational  deductions  for  those  occa- 
sions upon  which  the  individual  is  called  upon  to  exercise  safe- 
guarding judgments  and  select  wise  plans  of  conduct  for  the  acquisi-., 
tion,  conservation,  and  improvement  of  health. 

(3)  The  protective  hygiene  of  the  venereal  diseases  developed 
through  the  health  habits  of  the  individual,  the  hygienic  regulations . 
of  his  home  (protective  group  hygiene),  and  the  hygienic  laws  and 
ordinances  of  the  community  in  which  he  lives  (protective  inter-, 
group  hygiene). 


REPOin  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       15 

(4)  The  preventive  hygiene  of  the  venereal  diseases  applied  to  all 
individuals  with  gonorrhea,  syphilis,  or  chancroid  in  a  communicable 
state,  making  it  impossible  for  such  disease  carriers  to  transmit  their 
disease  to  others. 

(5)  The  remedial  hygiene  of  these  diseases  providing  for  their 
rapid  and  effective  cure. 

(6)  The  reconstructive  hygiene  of  venereal  disease  carriers  (the- 
prostitute)  bringing  to  them  the  ability  to  support  themselves  in 
health  and  comfort  without  having  to  resort  to  prostitution  for  a 
"  livelihood." 

The  i^rogram  of  the  United  States  Interdepartmental  Social 
Hygiene  Board,  as  laid  out  and  made  possible  by  Congress  this  year, 
provides  for  each  of  the  main  factors  in  the  hygiene  of  these  diseases: 
described  above. 

In  the  two  years  ending  June  30,  1920,  the  United  States  Govern- 
ment has  invested  $537,900  in  the  program  of  educational  hygiene  in 
colleges,  universities,  and  other  suitable  institutions.  This  sum  was 
more  than  matched  by  the  institutions  to  which  these  appropriations 
were  made,  so  that  it  may  be  estimated  safely  that  in  these  two  years 
the  total  joint  institutional  and  Federal  appropriation  for  educa- 
tional hygiene  amounted  to  $1,500,000. 

As  described  in  more  detail  in  Part  II  of  this  report,  the  depart- 
ments of  hygiene  that  have  been  established  or  enlarged  with  the 
help  of  the  Interdepartmental  Social  Hygiene  Board  in  39  normal 
schools,  colleges,  and  universities  will  reach  each  year  35,000  or 
40,000  3^oung  men  and  young  women  who  will  carry  the  influence  of 
their  instruction  into  their  homes  in  future  years  as  parents,  into 
schools,  colleges,  and  universities  as  teachers,  and  into  communities 
of  the  country  as  influential  citizens.  It  is  obvious  that  these  invest- 
ments of  the  Government  placed  in  stable,  well-organized,  and  well- 
established  educational  institutions  become  instrumental  in  the  de- 
velopment of  programs  of  education  that  will  endure  as  long  as  those 
institutions  last.  Even  now,  in  spite  of  the  short  period  of  time  in 
which  these  investments  have  been  made,  there  is  convincing  evidence 
that  the  experienced  educational  intelligence  of  the  institutions  con- 
cerned is  being  focused  uniformly  upon  an  improvement  in  their 
instruction  and  upon  measures  whereby  that  instruction  shall  in- 
fluence all  of  the  students  that  pass  through  their  courses. 

These  same  appropriations  from  the  educational  fund  for  the 
establishment  or  enlargement  of  departments  of  hygiene  in  normal 
schools,  colleges,  and  universities  are  instrumental  in  securing  a  very 
important  distribution  of  informational  hygiene,  emphasizing  pro- 
portionately the  hygiene  of  the  venereal  diseases.  As  stated  in  a 
subsequent  chapter  of  this  report,  great  care  is  exercised  to  discourage 


16       KEPOKT  U.  S.  INTERDEPAETMENTAIi  SOCIAL  HYGIENE  BOAKD. 

the  overemphasis  or  the  disproportionate  emphasis  of  these  diseases 
in  their  regular  curriculum. 

Scientific  research  for  the  acquisition  of  reliable  and  trustworthy- 
information  concerning  the  hygiene  of  gonorrhea,  syphilis,  and 
chancroid  is  the  purpose  for  which  the  board  has  made  appropria- 
tions during  the  last  two  years  amounting  to  $200,000  from  the  scien- 
tific research  fund  and  $62,100  from  the  educational  research  and 
development  fund  for  specific  medical,  educational,  sociologic,  and 
psychologic  investigation  of  important  problems  in  this  field.  In- 
formational hygiene  sought  through  these  researches  is  described  in 
more  detail  in  the  second  division  of  this  report.  It  may  be  said  in 
passing  that  this  research  program  carried  on  with  the  help  of 
the  Government  in  the  medical  schools  and  universities  of  America 
has  called  into  service  a  fairly  large  group  of  the  best-trained  men 
and  women  in  America,  and  gives  promise  of  results  that  will  repay 
the  Government  and  the  people  of  the  United  States  many  times 
over  the  amount  invested.  ^  The  profits  upon  these  investigations 
will  be  reckoned  in  terms  of  better  informed,  and  therefore  a  better 
protected  citizenship ;  a  reduced  cost  of  treatment  and  more  rapid 
€ure  for  these  diseases;  and  a  general  reduction  in  the  economic, 
social,  and  biologic  damage  hitherto  sustained  by  the  men,  women, 
and  children  of  America  because  of  the  present  expensive,  difficult, 
and  tedious  treatment  involved. 

The  appropriation  administered  by  the  board  "  for  the  assistance 
of  the  States  in  the  care  of  civilian  persons  *  *  *  for  the  pro- 
tection of  the  military  and  naval  forces  of  the  United  States  against 
venereal  diseases  "  has  been  applied  in  the  States  for  the  develop- 
ment and  operation  of  social  measures  protecting  soldiers,  sailors, 
and  civilians  from , exposure  to  the  venereal  diseases.  These  protec- 
tive measures  involve  the  closure  of  red-light  districts,  houses  of 
prostitution  and  houses  in  which  prostitution  is  carried  on.  This 
program  of  protective  hygiene  against  the  venereal  diseases  pro- 
tects the  individual  and  the  community  against  the  programs  and 
machineries  of  prostitution  as  carried  on  in  the  low-class  dance  hall, 
the  house  of  assignation  and  the  place  of  public  amusement  in  which 
plans  are  systematically  made  for  prostitution.  Under  this  fund  the 
agents  of  the  board  assigned  to  work  under  the  direction  of  State 
commissioners  of  health,  and  who  are  assigned  to  the  work  where 
local  conditions  are  bad,  are  often  brought  into  advisory  and  coun- 
seling relationship  Avhich  enables  them  to  assist  in  the  formulation 
of  laws,  ordinances,  and  regulations  for  the  protection  of  the  home 
and  the  community  against  prostitution  and  its  ramified  program. 

The  appropriation  made  by  Congress  from  which  allotments  are 
made  to  fetates  for  the  prevention,  treatment,  and  control  of  venereal 
diseases  through  their  respective  departments  of  health,  has  made 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       17 

possible  the  establishment  of  divisions  of  venereal  diseases  in  those 
States  and  has  led  to  the  enactment  of  laws,  ordinances,  and  regula- 
tions under  the  advice  and  assistance  of  the  United  States  Public 
Health  Service,  whereby  the  preventive  hygiene  and  the  remedial 
hygiene  of  gonorrhea,  syphilis,  and  chancroid  have  been  given  a 
powerful  and  growing  support  in  each  of  those  States.  The  legisla- 
tive enactments,  the  ordinances,  and  the  regulations  that  have  been 
established  have  been  directed  in  large  measure  toward  the  control 
of  the  individual  carrier  of  those  diseases  so  that  he  will  be  prevented 
from  transmitting  his  diseases  to  others. 

The  venereal  disease  clinics  established  under  this  appropriation 
have  applied  remedial  measures  to  an  enormous  number  of  men  and 
women  who  come  to  them  for  treatment.  During  this  last  year 
126,000  individuals  were  treated  in  these  clinics. 

The  reconstructive  hygiene  of  the  venereal  diseases  has  been  sup- 
ported this  last  year  in  part  by  the  appropriation  of  the  board  that 
is  concerned  with  the  care  of  civilian  persons,  as  described  above, 
and  in  part  by  the  appropriation  which  has  been  allotted  to  States  for 
the  prevention,  treatment,  and  control  of  venereal  diseases.  From 
the  first  of  these  two  appropriations  over  $100,000  was  paid  out  this 
last  year  for  the  assistance  of  detention  houses  and  reformatories 
to  which  were  committed  women  with  venereal  disease  who  were 
thought  to  be  a  menace  to  the  Army  and  to  the  Navy.  The  purpose 
laid  down  in  each  one  of  these  appropriations  from  the  board  was 
concerned  with  influencing  these  unfortunate  persons,  through  medi- 
cal and  social  treatment,  to  return  to  a  physical  and  social  status 
which  would  enable  them  to  resume  a  normal  and  safe  relationship 
in  community  life.  This  assistance  was  given  to  16  of  these  insti- 
tutions. 

The  second  appropriation  noted  above,  the  allotment  to  States  for 
the  prevention,  treatment,  and  control  of  venereal  diseases,  has  led 
each  State  commissioner  of  health,  who  is  cooperating  with  the  Gov- 
ernment under  his  allotment,  to  lay  plans  for  the  rehabilitation  of 
the  prostitute,  or  for  her  long-time  commitment  to  institutional  life, 
for  the  protection  of  the  citizens  of  his  State  and  of  the  Nation  from 
further  infection.  It  is  wholly  safe  to  assume  that  the  pressing  need 
for  a  program  of  reconstructive  hygiene  in  the  interest  of  the  pros- 
titute will  lead  to  the  ultimate  establishment  in  every  State  of  pro- 
visions for  the  long-time  commitment  or  for  the  ultimate  restoration 
of  the  delinquent  woman  or  girl  to  useful  community  life. 

It  is  obvious  from  this  rapid  summary  of  the  work  of  the  board 

that  the  four  appropriations  made  by  Congress  in  the  interest  of 

social  hygiene  are  being  administered  by  the  board  in  conformity 

with  a  well  organized  plan  which  covers  the  entire  field  of  the  hygiene 

15610—20 '-2 


18       REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

of  these  diseases.  It  is  evident,  however,  that  the  control  and  the 
eradication  of  these  diseases  will  not  be  accomplished  for  a  great 
many  years  to  come.  The  achievements  of  the  past  year  in  each  of 
these  several  activities  are  most  encouraging  and  justify  most  com- 
pletely the  financial  investment  and  the  thought  and  the  energy  put 
into  them,  but  the  progress  made  up  to  date  is  very  small  compared 
with  the  progress  that  must  be  made  before  we  have  a  control  over 
gonorrhea,  syphilis,  and  chancroid  that  will  be  comparable  with  the 
control  that  has  been  developed  through  other  agencies,  assisted  by 
the  Government,  in  relation  to  such  diseases  as  yellow  fever,  cholera, 
malaria,  typhoid  fever,  smallpox,  hookworm,  and  bubonic  plague. 
The  control  of  the  venereal  diseases  is  very  much  more  difficult  be- 
cause of  their  relationship  to  elemental  emotions  fundamental  to  the 
continuity  of  human  life.  With  a  continuation  of  governmental 
assistance,  and  with  an  increasingly  larger  self-support  from  the 
States,  a  satisfactory  control  of  these  diseases  should  be  ultimately 
secured. 

'^n  reviewing  the  work  of  the  board  for  this  past  year  it  is  im- 
possible to  arrive  at  a  satisfactory  estimate  of  progress  made  without 
taking  into  consideration  the  short  period  of  time  in  which  the 
board  has  been  operative,  and  particularly  the  unavoidable  delays 
that  retarded  the  initiation  of  nearly  all  of  the  activities  which  the 
board  was  finally  called  upon  to  support. 

While  it  is  true  that  on  June  30,  1920,  the  United  States  Inter- 
departmental Social  Hygiene  Board  completed  the  second  year  of 
its  legal  existence,  it  is  also  true  that  for  various  reasons  stated  else- 
where 2  this  second  year  of  legal  existence  has  been  hardly  more  than 
the  first  year  of  its  real  activity  in  any  of  the  several  divisions  of 
work  authorized  and  required  by  Congress. 

The  more  complete  organization  of  the  administrative  office  of  the 
board  was  necessarily  delayed  until  July  1,  1919.  Prior  to  that 
date  this  administrative  organization  was  unavoidably  incomplete 
because  of  inadvertencies  in  the  act  creating  the  board  and  outlining 
its  obligations. 

The  major  activities  of  the  board  were  correspondingly  delayed. 
The  administration  of  the  field  service  concerned  with  protective 
social  measures  was  turned  over  to  the  board  on  April  1,  1919.  Ap- 
propriations for  scientific  research  for  the  discovery  of  more  effec- 
tive medical  measures  in  the  prevention  and  treatment  of  venereal 
diseases  were  made  to  only  three  universities  before  June,  1919. 
Eleven  more  institutions  were  added  during  that  month.  It  is  evi- 
dent that  the  research  activities  made  possible  by  these  grants  could 
not  have  been  actually  under  way  prior  to  June,  1919,  and  probably 

a  Manual  for  the  Various  Agents  of  the  United  States  Interdepartmental  Social  Hygiene 
Board.     (See  Part  III.) 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       19 

not  before  September  of  that  year,  when  the  college  and  university 
year  began.  Appropriations  from  the  educational  fund  were  de- 
layed in  like  manner.  No  payments  were  made  to  colleges,  univer- 
sities, or  other  suitable  institutions  or  organizations  "  for  the  pur- 
pose of  discovering  and  developing  more  effective  educational  meas- 
ures in  the  prevention  of  venereal  diseases  for  the  purpose  of  socio- 
logical and  psychological  research  related  thereto "  until  the  first 
year  of  the  board  was  practically  gone.  None  of  these  educational 
investments  of  the  Government  became  active  or  could  have  become 
active  before  September,  1919,  well  into  the  second  year  of  the  board. 

The  allotments  to  the  States  for  the  prevention,  treatment,  and 
control  of  the  venereal  diseases  were  paid  over  to  the  States  as  fast 
as  they  qualified  after  SejDtember,  1918.  This  one  fund  was,  in  the 
nature  of  things,  more  easily  invested  in  accord  with  the  direction 
of  Congress  than  were  any  of  the  others.  However,  it  must  be  noted 
that  the  board  was  unable  to  develop  satisfactorily  a  disbursing  and 
accounting  system  for  this  fund  until  a  resource  for  administrative 
purposes  had  been  made  available  by  Congress  in  July,  1919. 

From  these  facts  it  is  clearly  evident  that  the  fiscal  year  ending 
June  30,  1920,  to  which  j^ear  this  report  is  directed,  was  really  the 
first  year  in  which  productive  activity  was  possible  in  connection 
with  any  of  the  various  governmental  investments  made  through 
the  board,  save,  to  a  limited  degree,  the  investment  allotted  to  the 
States  for  the  use  of  their  respective  boards  or  departments  of  health 
in  the  prevention,  treatment,  and  control  of  venereal  diseases  "in 
accordance  with  the  rules  and  regulations  prescribed  by  the  Secretary 
of  the  Treasury." 

This  year,  then,  has  been  a  year  of  organization,  of  investment, 
and  of  improvement.  Comparing  June  30,  1920,  with  June  30,  1919, 
we  find  that  the  governmental  investments  in  scientific  researches 
under  the  board  have  increased  from  26  researches  in  14  institutions 
to  36  researches  in  22  institutions,  and  that  all  of  these  research 
investments  were  at  work  during  this  year  and  that  they  give  prom- 
ise of  profit. 

The  investments  made  by  the  board  for  the  Government  from  the 
educational  research  and  development  fund  have  increased  from 
investment  made  last  year  assisting  28  normal  schools,  colleges,  and 
universities  to  establish  or  enlarge  their  departments  of  hygiene,  for 
the  purpose  of  emphasizing  proportionately  the  hygiene  of  venereal 
diseases  in  the  instruction  of  their  young  men  and  young  women 
students,  to  39  normal  schools,  colleges,  and  universities  under  agree- 
ment with  the  board  to  emphasize  the  hygiene  of  these  diseases  with 
appropriate  and  due  proportion  and  with  proper  tact  and  per- 
sistency. The  appropriations  made  from  this  fund  last  year  reached 
some  28,000  young  men  and  women  during  the  present  academic 


20       REPORT  U.  S.  INTERDEPAETMENTAL,  SOCIAL  HYGIENE  BOARD. 

year.  The  appropriations  made  from  this  fund  this  year  will  in- 
crease this  number  to  about  40,000  during  the  coming  academic 
year  1920-21.  Last  year  one  appropriation  was  made  from  this 
fund  for  psychological  research  in  accordance  with  the  provisions  of 
our  act.  This  research  is  practically  complete  at  the  end  of  the 
fiscal  year  1920.  (See  p.  151.)  This  year  appropriations  have  been 
made  for  16  psychological,  sociological,  and  educational  researches. 
Of  these,  3  have  been  completed  within  the  year  (see  p.  153).  The 
other  13,  because  of  necessity  of  protracted  research  or  because  allot- 
ments were  made  late,  will  be  carried  over  into  the  coming  academic 
year. 

The  protective  social  measures  program  of  the  board  last  year 
reached  65  cities.  This  year  15  State  departments  of  health  have 
taken  over  the  direction  of  workers  assigned  them  by  the  board  and 
8  others  are  ready  to  do  so  as  soon  as  competent  personnel  is  avail- 
able through  the  Federal  civil  service.  In  all,  the  board  has  located 
under  this  same  appropriation  149  workers  in  51  cities.  This  same 
fund  supplied  resource  last  year  amounting  to  $66,160.98  for  the 
maintenance  of  venereal  disease  carriers  in  17  reformatories,  deten- 
tion homes,  and  hospitals.  This  year  $106,199.46  has  been  paid  out 
to  16  such  institutions,  assisting  in  the  provision  of  96,842  days' 
treatment  as  compared  with  64,462  days'  treatment  last  year. 

Last  year  46  States  adopted  the  rules  and  regulations  issued  by 
the  United  States  Treasury  and  by  the  United  States  Interdepart- 
mental Social  Hygiene  Board  for  participation  in  the  allotment  to 
States  for  the  use  of  their  boards  or  departments  of  health  in  the 
prevention,  treatment,  and  control  of  venereal  diseases.  This  year 
46  States  adopted  these  rules  and  regulations  and,  in  addition,  satis- 
fied the  governmental  requirement  that  they  match  each  dollar  re- 
ceived from  the  Government  with  $1  appropriated  or  otherwise  set 
aside  by  the  State.^  The  divisions  of  venereal  diseases  established 
in  each  of  these  46  States  and  supported  by  State  funds  and  by  gov- 
ernmental funds  allotted  through  the  Interdepartmental  Social  Hy- 
giene Board,  and  carrying  on  their  activities  in  conformity  with 
regulations  laid  down  by  the  Secretary  of  the  Treasury,  have  reported 
to  the  Division  of  Venereal  Diseases  of  the  United  States  Public 
Health  Service  a  tremendous  growth  in  activities  this  year  compared 
with  the  same  activities  last  year." 

Last  year  the  office  of  the  board  (central  administrative  office) 
was  concerned  almost  wholly  with  disbursements  from  the  one  fund 
carrying  allotments  to   State  departments  of  health,  and  with  a 

*Tlie  Division  of  Venereal  Diseases  of  the  United  States  Public  Health  Service  covers 
the  details  of  this  program  in  the  States  In  its  annual  report. 

*  See  p.  99  for  a  summary  of  work  carried  on  under  th.is  joint  fund  for  the  fiscal  year 
ending  June  30, 1920. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       21 

limited  correspondence  with  the  universities,  colleges,  and  other 
suitable  institutions  or  organizations  qualified  for  scientific  research. 
Latterly,  that  is,  after  April,  1919,  the  central  office  was  assigned 
certain  administrative  personnel  from  another  governmental  depart- 
ment to  direct  the  "  law  enforcement  section  "  in  the  field.  This  sec- 
tion would  otherwise  have  been  without  direction.  This  year  the 
central  office  has  been  called  upon  for  a  steadily  increasing  service 
in  connection  with  the  five  funds  under  its  administrative  and  execu- 
tive supervision.  This  service  necessarily  covered  not  only  the  safe- 
guarded investment  of  more  than  $2,000,000  in  accordance  with  pro- 
visions and  requirements  of  Congress  and  the  United  States  Interde- 
partmental Social  Hygiene  Board,  but  it  Avas  called  upon  also  to 
cover  the  inspection  and  investigation  of  investments  made  in  the 
preceding  year  amounting  to  over  $1,500,000.  Moreover,  the  financial, 
legal,  scientific,  administrative,  medical,  hygienic,  informational,  edu- 
cational, social,  moral,  and  basic  human  factors  involved  in  the  pro- 
gram of  the  board,  as  laid  out  hj  Congress,  call  for  a  very  high  type 
and  a  varied  type  of  special  personal  service  in  the  central  office. 
The  success  of  this  difficult  and  complicated  program  depends  upon 
the  quality  of  the  personal  service  which  puts  that  program  into 
operation. 

SUMMARY  or  ACCOMPLISHMENTS. 

In  conclusion,  the  most  important  accomplishments  of  the  board 
during  the  year  ending  June  30,  1920,  may  be  summarized  concisely 
as  follows : 

1.  Appropriation  for  the  care  of  civilian  persons,  etc. — 
(a)  The  protective  social  measures  program  developed  under  this 
appropriation  has  been  carried  on  by  a  field  force  which  in  June, 
1920,  numbered  149  employees.  The  demand  of  the  States  for  this 
service  is  such  that  the  board  has  at  this  time  more  than  50  unfilled 
positions.  This  field  personnel  has  been  assigned  to  work  directly 
under  State  commissioners  of  health  in  15  States.  In  the  other 
States  in  which  there  are  military  and  naval  units  of  importance 
agents  have  been  assigned  to  cities  and  regions  in  which  it  has  been 
found  important  to  protect  soldiers,  sailors,  and  the  civilian  popula- 
tion from  the  carriers  of  venereal  disease.  As  a  result  of  this 
service,  18  red-light  districts  have  been  investigated  and  closed  in 
neighborhoods  more  or  less  remote  from  military  and  naval  estab- 
lishments, and  no  red-light  district  has  been  maintained  during  this 
year  in  the  near  neighborhood  of  military  or  naval  posts.  In  closing 
these  18  segregated  districts  in  its  search  for  the  foci  of  venereal  dis- 
ease, the  service  of  the  board  assisted  in  the  closing  of  the  214  houses 
in  which  703  women  were  found  engaged  in  prostitution ;  719  houses 
of  prostitution  were  closed  outside  of  red-light  districts;  programs 


22       REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD. 

of  prostitution  were  suppressed  in  646  places  other  than  in  houses 
of  prostitution ;  55  regions  were  placed  "  out  of  bounds  "  by  military 
and  naval  authorities;  10,129  men  were  arrested  because  of  their 
relationship  with  prostitution;  260  citizens'  committees  or  organiza- 
tions were  formed  or  stimulated  to  action  in  favor  of  protective 
social  measures  and  law  enforcement;  and  17,000  prostitutes  were 
observed  in  relation  to  their  activities  in  a  search  for  evidence  as  to 
the  existence  of  prostitution  or  its  programs. 

Furthermore,  this  field  service  has  carefully  investigated  this  last 
year  7,351  new  cases  of  delinquent  women  and  girls  who  were  thought 
to  be  a  menace  to  soldiers  and  sailors,  and  who  certainly  were  a 
menace  to  the  civilian  population.  With  these  new  cases  the  total 
number  of  individual  women  and  girls  given  especial  attention  by 
this  service  reached  25,459  for  the  period  subsequent  to  January  1, 
1919.  It  is  impossible  to  estimate  with  any  precision  the  gain  in  the 
campaign  against  the  venereal  diseases  achieved  by  closing  933  houses 
of  prostitution  or  by  abolishing  18  red-light  districts  or  by  keeping- 
other  such  districts  closed.  It  is  obvious,  however,  that  such  accom- 
plishments must  result  in  a  very  large  diminution  of  exposures  to 
gonorrhea,  syphilis,  and  chancroid,  and  consequently  to  a  very  large 
reduction  in  the  occurrence  of  such  infections.  Furthermore,  it  is 
obvious  that  the  7,351  delinquent  women  and  girls  brought  under 
the  special  influence  of  the  agents  of  this  board  must  have  been 
deterred,  for  a  period  of  time  at  least,  from  the  continuation  of  their 
delinquenc}''.  The  same  influence  must  have  been  exercised  to  some 
extent  at  least  upon  the  17,000  prostitutes  observed  by  the  field  service 
and  the  10,000  men  arrested.  Some  of  these  men  and  women,  how 
many  we  do  not  know,  were  permanently  led  away  from  prostitu- 
tion. One  can  not  estimate  accurately  the  effect  of  this  influence  of 
our  field  service.  For  instance,  a  report  on  prostitution  in  New 
York  City  some  years  ago  indicated  that  the  prostitute  in  New 
York  at  that  time  associated  on  the  average  with  10  men  or  boys  in 
each  period  of  24  hours.  One  can  not  guess  at  the  number  of  such 
associations  that  have  been  prevented  through  our  influence  upon 
these  houses,  these  men,  and  these  women. 

(b)  During  this  year  $106,299.46  was  distributed  from  this  fund 
to  16  reformatories,  training  schools,  detention  hospitals,  and  vene- 
real disease  quarantine  hospitals  in  which  were  confined  women  and 
girls  with  venereal  diseases,  who  were  thought  to  be  a  menace  to  sol- 
diers and  sailors.  With  this  appropriation  the  board  was  enabled  to 
give  assistance  in  the  maintenance  and  subsistence  of  these  inmates 
which  can  be  reckoned  best  perhaps  in  terms  of  the  total  number  of 
days  which  such  "  treatment "  covered.  Our  records  indicate  that 
the  actual  number  of  days'  "  treatment "  given  by  these  institutions 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       23 

during  this  period  of  time  was  96,842.  In  other  words,  the  appro- 
priation of  the  board  would  have  maintained  one  inmate  for  96,842 
days. 

Here,  again,  it  is  not  possible  to  estimate  the  value  of  this  assistance 
with  any  accuracy.  The  fact  that  each  inmate  was  prevented  from 
exposing  soldiers,  sailors,  and  civilians  during  the  period  of  time 
for  which  she  was  confined  in  the  institution  makes  it  clearly 
evident  that  this  assistance  from  the  Government  was  at  least  tem- 
porarily effective  in  the  protection  of  men  in  the  Army  and  in  the 
Navy  and  men  and  women  in  the  civilian  population  of  the  United 
States  from  these  disease  carriers.  It  is,  perhaps,  unjustifiable  to 
assume  that  these  inmates  all  averaged  10  exposures  a  day  while 
they  were  engaged  in  prostitution,  nevertheless  the  fact  that  such 
an  average  has  been  ascribed  to  that  profession  would  give  a  great 
deal  of  weight  to  the  importance  of  these  96,842  days  of  "  treatment." 

2.  Appropriation  for  allotment  to  States  for  the  prevention,  treat- 
ment, and  control  of  venereal  diseases — 

Under  this  appropriation  46  States  huxe  adopted  programs  of 
prevention,  treatment,  and  control  of  venereal  diseases  as  promul- 
gated by  the  Secretary  of  the  Treasury.  During  this  year  326,000 
cases  of  venereal  diseases  were  reported  to  the  State  commissioners 
of  health  and  126,000  cases  were  treated  in  clinics  operated  under 
this  program  laid  out  by  the  Secretary  of  the  Treasury  and  sup- 
ported by  the  allotment  paid  out  by  the  Interdepartmental  Social 
Hygiene  Board.  Informational  programs  have,  been  carried  out  in 
each  of  these  46  States  carrying  facts  to  the  public  through  lectures, 
posters,  pamphlets,  moving-picture  films,  lantern  slides,  and  other 
graphic  media.  It  is  probably  true  that  the  main  facts  connected 
with  the  hygiene  of  the  venereal  diseases  are  better  known  to  the 
American  public  to-day  than  ever  before  because  of  this  informa- 
tional program  that  has  been  carried  by  the  Division  of  Venereal 
Diseases  of  the  Public  Health  Service  and  by  the  departments  of 
health  of  46  of  our  States.  Furthermore,  through  this  appropriation 
legislation  regulations  and  ordinances  for  the  protection  of  the 
public  and  for  the  prevention  of  these  diseases  have  been  adopted 
to  greater  or  lesser  extent  in  each  of  these  46  States  during  these  last 
two  years. 

While  it  is  not  possible  to  evaluate  the  importance  of  this  phase 
of  our  program  with  any  exactness,  it  is  evident  that  these  measures 
are  exerting  an  enormous  influence  for  the  cure  of  venereal  diseases 
and  for  their  medical  prevention  and  control. 

3.  Appropriation  for  the  purpose  of  discovering  more  effective 
medical  measures  in  the  prevention  and  treatment  of  venereal 
diseases — 


24       REPORT  U.  S,  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

On  June  30,  1920,  there  were  35  researches  being  carried  on 
m^  22  of  the  best  American  medical  schools  and  universities  in  a 
scientific  search  for  better  methods  in  the  prevention  and  treatment 
of  the  venereal  diseases:  The  results  from  these  research  activities 
will  not  appear  until  sufficient  time  has  elapsed  for  careful,  thorough, 
and  painstaking  investigation.  The  possibilities  of  profitable  return 
from  these  investments  of  the  Government  are  most  promising. 
Information  of  value  to  the  individual,  to  the  home,  and  to  the  com- 
munity will,  in  all  probability,  be  secured  through  some,  at  least, 
of  these  investigations.  A  single  one  of  them  may  very  easily  reduce 
the  time  and  the  cost  of  treatment  to  an  extent  that  would  represent 
a  saving  of  millions  of  dollars  in  wages  because  of  time  saved,  and 
a  saving  of  millions  of  dollars  in  cost  of  treatment  because  of  im- 
proved methods  of  treatment,  or  because  of  cheaper  medication. 
When  one  realizes  that  during  this  last  year  the  problem  of  treat- 
ment alone  involved  over  14,000  cases  in  the  Army,  over  21,000  cases 
in  the  Navy,  and  possibly  more  than  1,500,000  cases  in  the  civilian 
population,  he  can  not  escape  the  conviction  that  there  is  every  reason 
to  expect  that  one  or  more  of  these  scientific  researches  will  result 
in  a  tremendous  gain  to  the  Government  and  to  the  people  of  the 
United  States  through  cheaper  medication,  or  through  more  effective 
methods  of  administration  or  through  new  and  more  effective  drugs. 
4.  Appropriation  for  the  purpose  of  discovering  and  developing 
more  effective  educational  measures  in  the  prevention  of  venereal 
diseases,  and  for  the  purpose  of  sociologic  and  psychologic  research 
related  thereto — 

Since  this  appropriation  became  actually  available  in  January, 
1919,  approximately  $520,000  has  been  paid  to  normal  schools,  col- 
leges, and  universities  for  the  establishment  and  enlargement  therein 
of  departments  of  hygiene  for  the  purpose  of  emphasizing  normally 
and  logically,  and  with  due  proportion,  the  hygiene  of  the  venereal 
diseases.  These  payments  have  been  made  to  39  normal  schools, 
colleges,  and  universities,  and  the  programs  which  have  been  made 
possible  thereby  have  reached  approximately  28,000  young  men  and 
women  this  year  and  will  reach  35,000  or  40,000  young  men  and 
young  women  the  coming  academic  year.  Here,  again,  it  is  impos- 
sible to  make  any  exact  estimate  of  the  returns  that  may  be  expected 
from  these  educational  investments.  It  is  inevitable,  however,  that 
with  the  best  educational  intelligence  of  the  country  devoted  to  the 
problem  our  future  citizenship  will  be  scientifically  and  practically 
informed  concerning  these  diseases  and  their  causes,  their  carriers, 
their  damages,  and  their  preventions.  It  is  already  clear  that  we 
may  expect  a  very  much  larger  number  of  educational  institutions  to 
adopt  this  departmental  organization,  and  that  an  increasingly  large 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL.  HYGIENE  BOARD.       25 

number  of  our  future  citizens  will  develop  habits  of  personal  health 
control  and  habits  of  home  protection,  and  measures  for  community 
protection  that  will  enormously  reduce  prostitution  and  venereal 
disease. 

The  most  important  division  of  activity'  assigned  to  the  Inter- 
departmental Social  Hygiene  Board  by  the  United  States  Govern- 
ment is  probably  represented  in  this  educational  program.  Ulti- 
mately education  and  the  information  which  it  carries  will  have  a 
very  much  larger  influence  upon  the  prevention  of  these  diseases  and 
upon  the  control  of  the  economic  and  social  and  educational  condi- 
tions that  lead  to  their  prevalence  than  will  any  other  influence  that 
has  been  brought  to  bear  for  the  control  or  eradication  of  these 
diseases. 


Pakt  II. 

Report  on  the  Activities  of  the  Several  Divisions  Under  the  United  States 
Interdepartmental  Social  Hygiene  Board. 

A.  Charts  of  appropriations,  functions,  and  personnel. 

B.  Reports  on  the  Division  of  Relations  with  States. 

(a)  Report  on  the  protective  social  measures  program. 

(5)  Assistance  in  the  maintenance  of  venereally  infected 
inmates  of  reformatories,  etc. 

(c)  Report  on  Medical  measures — Cooperation  of  the  Di- 
vision of  Venereal  Diseases  of  the  United  States 
Public  Health  Service,  State  boards  or  departments 
of  health,  and  the  Interdepartmental  Social  Hygiene 
Board. 

C.  Report  on  the  Division  of  Scientific  Research. 

D.  Report  on  the  Division  of  Educational  Research. 

E.  Report  on  the  Business  Office. 

Charts  of  Appropriations,  Functions,  and  Personnel,  Compiled 
IN  Satisfaction  of  Congressional  Action. 

Chart  1.  Funds  and  Their  Purposes. 

Chart  2.  Administrative  Fund,  Purposes  and  Personnel. 

Chart  3.  "Aid  to  States  "  Fund,  Purposes  and  Personnel. 

Chart  4.  "  Payment  to  States  "  Fund,  Purposes  and  Personnel. 

Chart  5.  Educational  Research  and  Development  Fund,  Purposes 
and  Personnel. 

Chart  6.  Scientific  Research  Fund,  Purposes  and  Personnel. 

Chart  7.  General  Organization. 

Chart  8.  Executive  Office. 

Chart  9.  Personnel  Section. 

Chart  10.  Business  Office. 

Chart  11.  Division  of  Records,  Information  and  Planning. 

Chart  12.  Division  of  Relations  with  States  (Protective  Medical 
Measures). 

Chart  13.  Division  of  Relations  with  States    (Protective  Social 
Measures). 

Chart  14.  Division  of  Educational  Research  and  Development, 

Chart  15.  Division  of  Scientific  Research. 

27 


SCIENTIFIC 
RESEARCH 
FUND— 

The  sum  of  $103,430, 
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leges or  other  institu- 
tions     qualified      for 
scientific  research  for 
more  effective  medical 
measures  in  the  pre- 
vention and  treatment 
of  venereal  diseases. 

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(28) 


ADMINISTRATIVE  FUND 


$100,000  for  personal  services,  books  of  refer- 
ence, periodicals,  printing,  binding,  traveling,  and 
other  necessary  expenses  of  the  Board  in  adminis- 
tering the  provisions  of  the  Federal  Lav?. 


EXECUTIVE  OFFICE,  BUSINESS  OFFICE,  HEADQUARTERS  DIVISIONS- 

(a)  Division  of  Relations  with  States. 

(b)  Division  of  Educational  Research. 

(c)  Division  of  Scientific  Research. 

(d)  Division  of  Records,  Information,  and  Planning. 

(e)  Personnel  Section. 


FUNCTIONS 

Administration  of  five  activities  for  which  Congress  has  made  appropriations — 

1.  Scientific  Research. 

2.  Educational  Research  and  Development. 

3.  Payments  to  State  Departments  of  Health  for  medical  treatment,  prevention,  and 

control  of  venereal  diseases. 

4.  Aid  to  States  in  caring  for  civilian  carriers  of  venereal  diseases: 

(a)  Protective  social  measures. 

(6)  Detention,  isolation,  quarantine,  commitment,  rehabilitation  of  infected. 

5.  Central  office  or  headquarters  administration. 


PERSONNEL  jjo. 

Executive  Secretary 1 

Superintendent  of  Field  Service — Educational  research  and  development 1 

Supervising  assistant  and  inspector 4 

Accountant  and  disbursing  ofiicer 1 

Secretary  to  executive  secretary 1 

Statistician 2 

Clerk 7 

Bookkeeper 1 

Stenographer .11 

Typist 7 

File  Clerk '. ,  3 

Coding  statistical  clerk 1 

Key-punch  operator 1 

Telephone  operator 1 

Messenger 2 

Draftsman  (part  time) 1 

Total  personnel 45 


UNITED  STATES 
INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 
Cliart  of 
ADMINISTRATIVE  FUND,  PURPOSES,  AND  PEBSONNKL 

&-3O-20 

(29) 


PAYMENT-TO-STATES  FUND 


The  sum  of  $1,087,831.42  to  be  paid  to  States  for 
use  of  their  respective  boards  of  health  in  the 
treatment,  prevention,  and  control  of  venereal 
diseases. 


DIVISION  OF  RELATIONS  WITH  STATES,— PROTECTIVE  MEDICAL  MEASURES, 
—COOPERATING  WITH  STATE  DEPARTMENTS  OF  HEALTH,  AND  WITH  THE 
DIVISION  OF  VENEREAL  DISEASES,  UNITED  STATES  PUBLIC  HEALTH 
SERVICE. 


FUNCTIONS  (OF  THE  BOARD) 

1.  To  inquire  into  the  legislative  action  of  the  various  States  in  order  to  ascertain  what 

States  have  made  appropriations  qualifying  them  under  the  conditions  laid  down 
by  Congress  for  participation  in  the  fund  set  aside  by  Congress  for  allotment  to  States 
for  the  treatment,  prevention,  and  control  of  venereal  diseases, 

2.  To  inquire  into  the  use  made  by  the  States  of  the  moneys  allotted  to  them  in  order  to 

learn  if  that  use  has  been  in  conformity  with  the  rules  and  regulations  established  by 
the  Government. 

3.  To  disburse  moneys  in  accordance  with  the  provisions  of  this  appropriation  and  to  carry 

on  a  safe  and  satisfactory  monthly  accounting  of  those  moneys. 


PERSONNEL 

This  work  is  directed  by  the  Executive  Secretary. 

Other  necessary  services  are  distributed  among  the  following: 

1.  Personnel  Section — Stenographic  and  clerical. 

2.  Business  Office — Disbursing,  auditing,  paying,  accoimting. 

,  3.  Division  of  Records,  Information,  and  Planning — Records,  information,  services 
(mimeograph,  addressograph,  etc.),  supplies. 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Cnart  of  PAYMENT-TO-STATES  FUND 

6-30-20 


(30) 


AID-TO-STATES  FUND 


The  sum  of  $784,376.84  for  the  purpose  of  assist- 
ing the  various  States  in  caring  for  civilian  persons 
whose  detention,  isolation,  quarantine,  or  commit- 
ment to  institutions  may  be  found  necessary  for  the 
protection  of  the  military  and  naval  forces  of  the 
United  States  against  venereal  diseases. 


DIVISION  OF  RELATIONS  WITH  STATES 


FUNCTIONS 

Unraer  this  Fund,  the  protective  social  service  of  the  Board  is  concerned  with— 

1.  Search  for  foci  of  venereal  disease  that  may  be  a  menace  to  soldiers,  sailors,  and 

civilians. 

2.  Identification  or  discovery  of  individuals  who  are  carriers  of  venereal  disease  and 

who  may  be  a  menace  to  soldiers  or  sailors. 

3.  Inquiry  into  the  reasons  and  conditions  that  have  led  these  individuals  to  become 

carriers  of  venereal  disease. 

4.  The  preparation  of  systematic,  accurate  reports  covering  the  activities  of  the  pro- 

tective social  agents  of  the  Board. 

5.  The  presentation  of  these  reports  to  law-enforcing  agencies  through  proper  chan- 

nels (that  is,  through  the  United  States  Interdepartmental  Social  Hygiene 
Board,  or  through  the  State  Department  of  Health,  or  directly,  as  may  be  deter- 
mined by  previous  arrangement  with  the  individual  agent  of  the  Board). 

6.  Follow-up  investigations  covering — 

(a)  The  use  made  of  evidence  submitted  to  law-enforcing  agencies.  The 
enforcement  of  laws  relating  to  the  prevention  of  venereal  disease. 

{b)  The  marshaling  of  cooperative  community  forces  for  the  enforcement 
of  laws  for  the  "care  of  civilian  persons  whose  detention,  isolation, 
quarantine,  or  commitment  to  institutions  may  be  found  necessary 
for  the  protection  of  the  military  and  naval  forces  of  the  United  States 
against  venereal  disease." 

(c)  The  conduct  of  individuals  subsequent  to  their  medical  or  social  treatment 

for  the  prevention  of  venereal  disease  and  the  eradication  of  prostitution. 

(d)  The  care  of  persons  while  they  are  quarantined,  isolated,  or  committed 

to  institutions  as  a  measure  for  the  protection  of  the  armed  military 
and  naval  forces  of  the  United  States. 

PERSONNEL— Employed  Under  Administrative  Fund 

Chief  of  Division— Executive  Secretary    1      I      Executive  assistant  (woman) 1 

Executive  assistant  (man) 1      |      Stenographers 2 


FIELD  PERSONNEL— Employed  Under  Aid-to-States  Fund 


Supervising  assistants  and  inspectors . .  9 

Supervisor  of  confidential  agents 1 

Field  agents 59 

Confidential  protective  social  agents..  10 

Assistant  field  agents 2 

Assistant  special  agents 29 

Stenographers 34 

Stenographers  (part  time) 6 

Total 150 


Unfilled  Positions. 
Supervising  assistants  and  inspectors. .     6 
Confidential  protective  social  agents. . .     5 

Field  agents .-SO 

Assistant  field  agents 0 

Assistant  special  agents : . .  46 

Stenographers _36 

Total 123 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Chart  of  AID-TO-STATES  FUND 

^.30-20 


(31) 


EDUCATIONAL    RESEARCH 
AND  DEVELOPMENT  FUND 


The  sum  of  $439,030  to  be  paid  to  such  uni- 
versities, colleges,  and  other  institutions  or  organiza- 
tions for  the  purpose  of  discovering  more  effective 
educational  measures  in  the  prevention  of  venereal 
diseases  and  for  the  purpose  of  sociological  and 
psychological  research  related  thereto. 


DIVISION  EDUCATIONAL  RESEARCH  AND  DEVELOPMENT 


FUNCTIONS 

1.  Select  colleges,  universities,  and  other  suitable  institutions  or  organizations  in  which  to 

discover,  develop,  and  demonstrate  more  effective  educational  measures  for  the 
prevention  of  venereal  diseases. 

2.  Select  colleges,  universities,  and  other  suitable  institutions  or  organizations  for  sociolog- 

ical and  psychological  research  for  better  methods  of  education  and  demonstration 
in  the  prevention  of  venereal  diseases. 

3.  Sift  and  judge  educational,  sociological,  and  psychological  researches  proposed. 

4.  Apply  the  rules  and  regulations  of  the  Board  as  required  by  law. 

5.  Determine  proper  sums  to  be  expended  for  educational  development,  improved  educa- 

tional methods,  and  for  sociological  and  psychological  research  in  the  various  institu- 
tions assisted  by  the  Board. 

6.  Approve  budgets  and  authorize  revisions, 

7.  Follow  up  and  check  these  investments  of  the  Government  in  order  to  ascertain  their 

usefulness. 

8.  Organize  and  publish  reports  from  educational  institutions  and  other  organizations  to 

which  funds  are  allotted  by  the  Board. 


PERSONNEL 


Division  Staff — 

Chief  of  Division,  Executive  Secretary. 

Superintendent  of  Field  Service 

Stenographer 


Note. — General  Services  furnished  this  Division  by — 
Executive  Office. 
Business  Office. 

Division  of  Records,  Information,  and  Planning. 
Personnel  Section. 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Cnart  of  EDTJCATIONAL  RESEARCH 

AND  DEVELOPMENT  FUND 

6-30-20 


(32) 


SCIENTIFIC  RESEARCH  FUND 


The  sum  of  $103,430,  which  shall  be  paid  to 
such  universities,  colleges,  or  other  institutions 
qualified  for  scientific  research  for  more  effective 
medical  measures  in  the  prevention  and  treatment 
of  venereal  diseases. 


DIVISION  OF  SCIENTIFIC  RESEARCH 


FUNCTIONS 

1.  Select  colleges,  universities,  and  other  suitable  institutions  for  scientific  research. 

2.  Sift  and   judge  researches  proposed    for  discovering  a^nd   developing  more  effective 

medical  measures  in  the  prevention  and  treatment  of  venereal  diseases. 

3.  Apply  the  rules  and  regulations  of  the  Board  as  required  by  law. 

4.  Determine  proper  sums  to  be  expended  for  approved  researches. 

5.  Approve  budgets  and  authorize  re^dsions. 

6.  Follow  up  disbursements  from  the  scientific  fund  to  determine  the  value  of  the  research 

work  done. 

7.  Prepare  reports,  technical  data,  memoranda,  and  bulletins. 


PERSONNEL 


A.  Division  Staff— 

Chief  of  Division,  Executive  Secretary. 

Supervising  assistant 

Stenographer 


Note. — General  services  furnished  by — 
Executive  Ofiice. 
Business  Office. 

Division  of  Records,  Information,  and  Planning. 
Personnel  Section. 


UNITED  STATES 
INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 
Chart  of  SCIENTIFIC   RESEARCH  FUND 

6-30-20 


15610—20 3 


(33) 


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Normal  schools,  colleges,  universi- 
ties, and  other   institutions   and 
organizations  carrying  on  educa- 
tional, sociological,  and  psychologi- 
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(34) 


CONGRESS 


INTERDEPARTMENTAL  SOCIAL 
HYGIENE  BOARD 


EXECUTIVE  COMMITTEE 


EXECUTIVE  OFFICE 


FUNCTIONS 


Executive  Secretary — 


1.  Authorized  and  responsible  agent  of  the  Board,  operating  all  of  its  policies  and 
applying  all  of  its  judgments  and  directing  and  coordinating  all  of  the  several 
divisions  under  the  Board: 

(a)  Division  of  Relations  with  States. 
(6)  Division  of  Scientific  Researches. 

(c)  Division  of  Educational  Research  and  Development. 

(d)  Division  of  Records,  Information,  and  Planning. 

(e)  Business  Office. 
(/)  Executive  Office. 


Secretary  to  Executive  Secretary — 

1.  As  senior  private  secretary: 

Relieves  the  executive  secretary  of  office  details:  conserves  his  time  by  super- 
vising work  of  his  immediate  office,  by  examining  letters  and  documents, 
and  by  taking  independent  action  in  disposing  of  all  matters  which  do  not 
require  his  personal  attention;  when  required,  represents  him  as  his  personal 
agent;  collects  and  interprets  information  as  a  basis  for  executive  action. 

2.  As  Chief  Clerk:  Supervises  personnel  section,  general  files,  telephone  exchange. 

PERSONNEL 

Executive  Secretaiy 1 

Secretary  to  the  Executive  Secretary : 1 

Stenographers 2 


PERSONNEL 
SECTION 

GENERAL 
FILES 

TELEPHONE 
EXCHANGE 

UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  HOARD 

Chart  of  EXECUTIVE  OFFICE 

f>-30-20  * 

(:i5) 


EXECUTIVE   SECRETARY 


SECRETARY  TO  EXECUTIVE  SECRETARY 


PERSONNEL    SECTION 


FUNCTIONS 

All  central  office  relations  with  Civil  Service  Commission. 

All  relations  with  Reclassification  Commission. 

Records  of  attendance,   assignments,  sick  leave,  vacations,  head- 
quarters personnel. 

Assignment   of   stenographic,    clerical,    accounting,   technical,    and 
other  personal  services  to  headquarters  divisions. 


PERSONNEL 


Personnel  Clerk. 


1 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Cliart  of  PERSONNEL  SECTION 

6-30-20 


(36) 


EXECUTIVE  SECRETARY 


BUSINESS   OFFICE 


FUNCTIONS 


1.  Disbursing. 

2.  Purchasing. 

3.  'Auditing. 

4.  Paying. 

5.  Accounting. 


In  connection  with  five  appropriations,  totahng 
$2,514,668.26,  for  all  Divisions  of  Board, 
Headquarters,  and  Field. 


PERSONNEL 

Accountant  and  Disbursing  Officer 1 

Bookkeepers 3 

Clerks ^ 3 

Typist . 1 

Typist  (unfilled) 1 

File  Clerk  1 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

CHart  of  BUSINESS   OFFICE,  FUNCTIONS, 

AND   PERSONNEIj 

6-30-20 

(37) 


EXECUTIVE  SECRETARY 


DIVISION  OF  RECORDS,  INFORMATION,  AND  PLANNING 


FUNCTIONS 

1.  Records — 

(a)  Gathering. 

(b)  Classifying. 

(c)  Analyzing. 

2.  Information — 

(a)  Preparation. 

(b)  Distribution. 

1.  To    Congress    and    other    Government 

authorities. 

2.  To  active  personnel. 

3.  To  the  public. 

3.  Assisting  Executive  Secretary  with  special  informa- 

tion as  required  in  connection  with  the  planning 
and  development  of  programs. 

4.  Supplies.  "" 

5.  General  services — 

(a)  Messengers. 


In  connection  with  activities  of 
all  Divisions  of  the  Board, 
Headquarters,  and  Keld. 


(6)  Mimeograph  and  mimeoscope. 
(c)  Addressograph. 


For  all  Headquarters  Divisions. 


PERSONNEL 

Chief  of  Division — Executive  Secretary. 

Supervising  assistant 1 

Statistician 1 

Assistant  statistician  (unfilled) 1 

Stenographers 2 

Coding  statistical  clerk  (unfilled) 1 


Key^punch  operator 

Chief  of  Services  and  Supplies 

Stock  clerk 

Mimeograph  operator 

Messengers  (2  unfilled) 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Chart  of  DIVISION  OP  RECORDS, 

INFORMATION,    AND    PLANNING 

6-30-20 

(38) 


EXECUTIVE  SECRETARY 


CHIEF  OF 
DIVISION  OF  RELATIONS  WITH  STATES 


(The  functions  of  this  section  are  satisfied  through  the  cooper- 
ation of  the  Division  of  Venereal  Diseases  of  the  United  States 
Public  Health  Service,  the  State  Departments  of  Health,  and  the 
Interdepartmental  Social  Hygiene  Board.) 

FUNCTIONS  (OF  THE  BOARD) 

1.  Ascertain  States  legally  qualified  for  Federal  allotment. 

2.  Inquire  into  use  made  of  allotments. 

3.  Disbursements  and  accounts. 


PERSONNEL 

This  work  is  directed  by  the  Executive  Secretary. 

Other  necessary  services  are  distributed  among  the  following: 

1.  Personnel  Section — Stenographic  and  clerical. 

2.  Business  Office — -Disbrn'sing,     auditing,     paying,     ac- 
.     counting. 

3.  Division  op  Records,  Information,  and  Planning — 

Records,  information  services  (mimeograph,  addresso- 
graph,  etc.),  supplies. 


PROTECTIVE 

SOCIAL 

MEASURES 

(See 
following  chart) 


STATE  DEPARTMENTS  OF  HEALTH  RECEIVING  FINANCIAL 
AID  FOR  PROTECTIVE  MEDICAL  MEASURES 


Cooperation  with  State  Boards  or  Departments  of  Health  by 
the  United  States  Public  Hoalth  Service,  Division  of  Venereal 
Diseases. 


(INITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Ciiart  of  DIVISION  OF  REI^ATIONS 

WITH    STATES 

6-30-20 


(39) 


EXECUTIVE  SECRETARY 


CHIEF  OF 
DIVISION  OF  RELATIONS  WITH  STATES 


PROTECTIVE 

MEDICAL 
MEASURES 

(See 
preceding  chart) 


PROTECTIVE  SOCIAL  MEASURES 


FUNCTIONS 

1.  Selection,  instruction,  assignment  of  qualified  personnel. 

2.  Establishment  and  maintenance   of   Bureaus   of  Protective 

Social  Measures  in  the  States. 

3.  Direction  of  Protective  Social  Measures  Agents  and  programs 

in  the  States. 
Maintenance  of  relations  with  the  Army,  Navy,  Department 
of  Justice,  Internal  Revenue,  Public  Health  Service,  State 
Departments  of  Health,  local  law  enforcing  agencies,  and 
national  civilian  agencies. 


4. 


Chief  of  Division,  Executive 

Secretary. 
Executive  Assistants 2 


PERSONNEL 

Case  Supervisor 1 

Report  Examiner  (unfilied). .  1 
Stenographers 2 


FIELD  STAFF  IN  MILI- 
TARY AND  NAVAL 
AREAS  REPORTING 
DIRECT  TO   BOARD. 


FUNCTIONS 

Discovery  of  local  machin- 
ery and  methods  of  pros- 
titution. 

Discovery  of  venereal  dis- 
ease carriers. 

Inquiry  into  causes. 

Reports  on  results. 

Inspection  and  advice  on — 

Use  made  of  information. 

Enforcement  of  laws. 

Marshaling  of  community 
forces. 

Legal,  medical,  hygienic, 
social  and  reconstructive 
treatment  of  infected 
persons. 

Conduct  of  infected  per- 
sons. 


PERSONNEL 

On 

duty 

Un- 
filled 

Total 

82 
G 
28 
20 
10 
20 

85 
5 

18 

32 
5 

2.5 

Supv.  Assts... 
Field  Agts.... 

Assts 

Conf.  Agts 

Stenos 

CONFIDENTIAL  PRO- 
TECTIVE SOCIAL 
AGENTS. 


FUNCTIONS 

Secure  definite  information 
on— 

Existence    of   prostitu- 
tion. 
Houses  of  prostitution. 
Houses  in  vt^hich  pros- 
titution is  carried  on. 
Programs    of   prostitu- 
tion. 
Report  to  Headquarters  or 
as  specially  directed. 


PERSONNEL 

1  Supervisor  of  Confidential 
Agents. 

10  Confidential  Agents  in 
,     Field. 

o  Confidential  Agents  (un- 
filled). 


STATE  HEALTH  OFFICERS 
DIRECTING  ASSIGNED 
PERSONNEL  UNDER 
AGREEMENT  WITH 
BOARD. 

FIELD  STAFF  ON  ASSIGN- 
MENT TO  STATE  BU- 
REAUS OF  PROTECTIVE 
SOCIAL  MEASURES. 


FUNCTIONS 

Discovery    of  local   machinery 

and  methods  of  prostitution. 
Discovery    of   venereal   disease 

carriers. 
Inquiry  into  causes. 
Reports  on  results. 
Inspection  and  advice  on — 

Use  made  of  information. 

Enforcement  of  laws. 

Marshaling  of  commujiity 
forces. 

Legal,  medical,  hygienic,  so- 
cial ,  and  reconstructive  treat- 
ment of  infected  persons. 

Conduct  of  infected  persons. 


PERSONNEL 


Total 

Supv.  Assts. 
Field  Agents 

Assts  

Stenos 


On 

duty 


Un- 
filled 


38 
1 
12 
14 
11 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Cnart  or  DIVISION   OF   RETjATIONS 

WITH   STATES 

6-30-20 

(JO) 


DIVISION   OF  EDUCATIONAL   RESEARCH   AND   DEVELOPMENT 


FUNCTIONS 

1.  Select  colleges,  universities,  institutions,  other  organizations  with  adequate  technical 

equipment,  personnel,  experience  in  educational  research. 

2.  Select  colleges,'  universities,  institutions,  other  organizations  with  adequate  technical 

equipment,  personnel,  experience  in  sociological  and  psychological  research. 

3.  Sift,  judge,  and  estimate  value  of  educational,  sociological,  and  psychological  researches 

proposed. 

4.  Apply  rules  and  regulations  of  the  Board  as  required  by  law. 

5.  Determine  sums  to  be  expended  on  approved  researches. 

6.  Approve  budgets  and  authorize  revisions. 

7.  Follow  up  disbui'sements  and  determine  value  of  research  work  done. 

8.  Prepare  reports,  technical  data,  memoranda,  and  bulletins. 


PERSONNEL 

Division  Staff — 

Chief  of  Division,  Executive  Secretary. 

Superintendent  of  Field  Service '. 1 

Stenographer 1 


Note. — General  Services  furnished  this  Division  by — 
Executive  Office. 
Business  Office. 

Division  of  Records,  Information,  and  Planning. 
Personnel  Section. 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Chart  of  DIVISION   OF   EDUCATIONAiL 

RESEARCH   AND   DEVEIjOPMENT 

6-30-20 


(41 


EXECUTIVE  SECRETARY 


DIVISION  OF  SCIENTIFIC  RESEARCH 


FUNCTIONS 

1.  Select  colleges,  univeraities,  other  institutions  with  adequate  technical  equipment, 

personnel,  experience  in  research. 

2.  Sift,  judge,  and  estimate  value  of  researches  proposed. 

3.  Apply  rules  and  regulations  of  Board  as  required  by  law. 

4.  Determine  sums  to  be  expended  on  approved  researches. 

5.  Approve  budgets  and  authorize  revisions. 

6.  Follow  up  disbursements  and  determine  value  of  research  work  done. 

7.  Prepare  reports,  technical  data,  memoranda,  and  bulletins. 


PERSONNEL 

A.  Division  Staff — 

Chief  of  Division,  Executive  Secretary. 

Supervising  Assistant 

»    Stenographer ^ 


Note. — General  services  furnished  this  division  by — 
Executive  office. 
Business  office.  ♦ 

Division  of  Records,  Information,  and  Planning. 
Personnel  Section. 


UNITED  STATES 

INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD 

Chart  of  DIVISION  OF  SCIENTIFIC 

RESEARCH 

6-30-20 


(42) 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       43 

REPORT  ON  THE  DIVISION  OF  RELATIONS  WITH  STATES. 

Report  on  Protective  Social  Measltres. 
appropkiation  and  congressional  authorization. 

Sbo.  2.  That  the  Secretary  oi'  War  and  the  Secretary  of  the  Navy  areliereby 
authorized  and  directed  to  adopt  measures  for  the  pui-pose  of  as.sisting  the 
various  States  in  caring  for  civilian  persons  whose  detention,  isolation,  quaran- 
tine, or  commitment  to  institutions  may  be  found  necessary  for  the  protection 
of  the  military  and  naval  forces  of  Ihe  United  States  against  venereal  diseases. 

Sec.   3.  *     *     * 

Sec.  4.  *     *     *  • 

Sec.  5.  That  there  is  h('rel)y  appropriated  ont  of  miy  money  in  the  Treasury, 
not  otherwise  appropriated,  the  sum  of  $1,000,00(J  to  he  expended  under  the  joint 
direction  of  the  Secretary  of  War  and  the  Secretary  of  the  Navy  to  carry  out 
the  provisions  of  section  2  of  this  chapter:  ProrifJerl,  That  the  appropriation 
herein  made  shall  not  hr-  do^enred  exclusive.  I)nt  shall  lie  in  addition  to  other 
appropriations  of  a  n;ore  general  cliai'acter  which  are  applicable  to  the  same  or 
similar  purposes.     (Chap.  XV,  Army  appropriations  bill,  .Tuly  9,  1018.) 

Under  the  provisions  of  this  appropriation  the  Secretary  of  War 
and  the  Secretar^^  of  the  Navy,  both  of  Avhom  are  members  of  the 
Interdepartmental  Social  Hygiene  Board,  authorized  that  board  to 
develop  tAvo  general  lines  of  activity  during  the  year  ending  June 
30,  1920.  The  first  plan  of  activity  is  concerned  with  the  develop- 
ment and  operation  of  a  program  of  protective  social  measures  which 
shall  assist  the  States  in  caring  for  the  civilian  persons  referred  to 
in  the  paragraph  below. 

The  second  of  these  activities  is  concerned  with  assistance  of  re- 
formatories, detention  houses,  and  A-enereal  disease  hospitals,  in  the 
maintenance,  subsistence,  and  treatment  of  civilian  persons,  whose 
detention,  isolation,  quarantine,  or  commitment  to  such  institutions 
has  been  found  necessary  for  the  protection  of  soldiers  and  sailors 
from  A^enereal  diseases. 

SociAi.  Measures  Program  or  the  United  States  Interdepart- 
mental SociAl  Hygiene  Boarb  for  the  Protection  of  Soldiers 
AND  SaHjOrs  from  Venereal  Diseases. 


1.  The  protective  social  measures  program  of  the  board  is  a  pro- 
gram of  search,  investigation,  formulation  of  reJDorts,  and  presenta- 
tion of  facts  for  the  construction  and  operation  of  programs  of 
protective  social  measures  and  for  the  effective  enforcement  of  laws 
relating  thereto,  by  duly  constituted  authorities  for  the  protection 
of  the  armed  military  and  naval  forces  of  the  United  States  against 
venereal  disease.^ 

1  Parsuant  to  sees.  2  and  5,  Chap.  XV,  Army  appropriations  l>ill  of  July  9,   1918. 


44        REPOET  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

2.  An  agent  of  the  board,  however,  ma}?  act  directly  as  a  law- 
enforcement  officer,  in  case  he  has  been  authoritatiA^ely  designated  as 
such  by  a  State  health  officer  or  some  other  governmental  agent 
competent  to  make  such  designation,  such  authorization  having  been 
approved  by  the  board.  In  such  an  event  the  State  health  officer 
or  other  authorired  agent  making  this  designation  of  law  enforcing 
authority  must  assume  responsibility  for  the  law  enforcing  acts  of 
the  agent  so  designated.  The  Interdepartmental  Social  Hygiene 
Board  will  not  be  responsible  for  the  law  enforcing  acts  of  agents 
to  whom  such  powers  have  been  delegated  by  local  officers  of  the  law. 
The  board  proposes  to  use  every  reasonable  measure  at  its  disposal 
to  influence  law  enforcing  and  related  agencies  to  meet  their  obliga- 
tions relative  to  the  prevention  of  venereal  diseases  and  the  conse- 
quent protection  of  the  armed  military  and  naval  forces  of  the  XTnited 
States.^ 

3.  The  protective  social  agents  of  the  board,  where  assigned  to 
service  in  a  State  department  of  health,  will  receive  their  directions 
from,  and  be  responsible  to,  the  chief  health  officer  in  the  State  de- 
partment of  health  to  which  they  are  assigned.  In  such  an  event  the 
chief  State  health  officer  will  be  responsible  for  the  wise  and  careful 
direction  of  those  agents  in  conformity  v/ith  his  agreement  Avith  the 
Indepartmental  Social  Hygiene  Board. 

4.  The  protective  social  agents  of  the  board,  where  assigned  to 
service  in  States,  cities,  or  regions  in  which  State  departments  of 
health  have  not  agreed  to  be  responsible  for  the  program  proposed 
by  the  board,  will  be  under  the  immediate  direction  of  the  board. 

5.  The  protective  social  service  of  the  board  Avill  be  concerned  with 
the  following : 

(1)  Search  for  foci  of  venereal  disease  that  may  be  a  menace  to 

soldiers  or  sailors. 

(2)  Identification  or  discovery  of  individuals  who  are  carriers  of 

venereal  disease  and  who  ma}'  be  a  menace  to  soldiers  or 
sailors. 

(3)  Inquiry  into  the  reasons  and  conditions  that  have  led  these 

individuals  to  become  carriers  of  venereal  disease. 

(4)  The  preparation  of  systematic,  accurate  reports  covering  the 

activities  of  the  protective  social  agents  of  the  board. 

(5)  The  presentation  of  these  reports  to  law  enforcing  agencies 

through  proper  channels  (that  is,  through  the  United  States 
Interdepartmental  Social  Hygiene  Board,  or  through  the 
State  department  of  health,  or  directly,  as  may  be  deter- 
mined by  previous  arrangement  with  the  individual  agent 
of  the  board) . 

1  Pursuant  to  sees.  2  and  5,  Chap.  XV,  Army  appropriations  bill  of  July  9,  1918. 


REPORT  U.  S.  JNTERJJEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       45 

(6)   FolloAv-up  investi<iations  c<)verjn<j: — 

(a)  The  use  made  of  evidence  submitted  to  law  enforcing 
agencies.  The  enforcement  of  hiws  relating  to  the 
prevention  of  venereal  disease. 

(6)  The  marshalling  of  cooperative  community  forces 
for  the  enforcement  of  laws  for  the  "  care  of  civ- 
ilian persons  whose  detention,  isolation,  quaran- 
•  tine,  or  commitment  to  institutions  may  be  found 

necessary  for  the  protection  of  the  military  and 
naval  forces  of  the  United  States  against  A'^enereal 
disease." 

(c)  The  conduct  of  individuals  subse(iuent  t(j  their  medi- 

cal or  social  treatment  for  the  prevention  of  ve- 
nereal disease  and  the  eradication  of  j^rostitution. 

(d)  The   care   of   persons   wdiile   they    are   quarantined, 

isolated,  or  committed  to  institutions  as  a  measure 
for  the  protection  of  the  armed  military  and  naval 
forces  of  the  United  States. 

II. 

The  protective  social  activities  noted  in  paragraph  5  above  may 
be  described  in  more  detail  as  follows : 

(1)  The  search  for  foci  of  venereal  diseases  referred  to  in  para- 

graph 5-(l)  wdll  cover— 

(a)  Investigations  for  the  discover}^  of  houses  of  prosti- 

tutip'n  and  houses  in  wdiich  prostitution  occurs. 

(b)  Inspection  of  streets,  parks,  dance  halls,  moving-pic- 

ture theaters,  depots,  hotels,  burlesque  theaters, 
taxicab  practices,  etc.,  in  a  search  for  the  machinery 
and  programs  of  prostitution  and  for  conditions 
that  favor  the  spread  of  venereal  disease. 

(2)  Identification  or  discovery  of  individuals  who  are  carriers  of 

venereal  diseases  and  who  may  therefore  be  a  menace  to 
soldiers  or  sailors,  referred  to  above  in  paragraph  5-(2), 
will  be  accomplished — 
':  (a)  Through  a  careful  and  guarded  investigation  of  per- 

sons named  in  reports  by  Army  and  Navy  surgeons 
as  sources  of  infections  that  have  developed  in 
soldiers  or  sailors,  taking  great  care  that  no  mis- 
takes are  made  and  that  no  publicity  occurs  to  the 
injury  of  innocent  persons. 
(b)  Through  cases  and  names  referred  to  the  agent  from 
venereal  disease  clinics  or  from  other  community 
agencies  from  which  information  of  this  type  may 


46       EEPOBT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIEITE  BOARD. 

be  secured,  again  taking  care  that  no  injurious  or 
embarrassing  publicity  occurs. 

(c)  Through  guarded  inquiry  into  cases  detained  by 
police  authority  under  the  law,  for  crime  or  mis- 
demeanor, making  special  effort  to  protect  women 
and  girls  from  exposure  to  public  curiosity,  and  to 
avoid  the  confusing  of  court  and  health  adminis- 
trative procedures. 

{d)  Through  personal  influences  on  individual  cases  con- 
tacted "  in  the  day's  work "  by  the  agent  of  the 
board. 

(3)  The  sj^stematic  inquiry  into  the  reasons  and  conditions  that 

have  led  these  individuals  to  become  carriers  of  venereal 
diseases,  noted  in  section  5- (3)  above,  may  be  made  in 
filling  in  the  case  record  forms  provided  by  the  Interde- 
partmental Social  Hygiene  Board.  These  very  important 
confidential  records  must  be  secured  with  extreme  care  if 
they  are  to  serve  a  useful  purpose  and  must  be  accurate. 

(4)  The  reports  contemplated  in  section  5- (4)  above,  should  be 

organized  systematically  and  with  absolute  accuracy. 
Evidence  that  is  not  wholly  dependable  should  be  de- 
scribed as  unreliable  and  given  an  approximate  valuation. 
These  reports  should  carry  all  available  evidence  of  the  in- 
fluence of  this  protective  social  measures  program  upon  the 
occurrence  of  the  venereal  diseases.  Report  forms  are  sup- 
plied by  the  board. 

(5)  The  presentation  of  summaries  or  selected  data  to  law  en- 

forcing agencies  through  proper  channel,  as  noted  above 
in  section  5- (5)  involves  first  the  selection  of  the  proper 
law  enforcing  agency,  and  second  the  utilization  of  the 
proper  channel  through  which  to  reach  that  agency. 

{a)  The  law  enforcing  agencies  usually  available  are : 
The  board  of  health;  the  police  department;  the 
mayor;  the  camp  commander:  the  ranking  naval 
officer;  the  court. 
{h)  The  channels  for  presentation  are :  The  United  States 
Interdepartmental  Social  Hygiene  Board,  the  State 
department  of  health  or  some  other  avenue  desig- 
nated by  the  board  or  by  the  department.  The  agent 
of  the  board  will  present  reports  through  the  chan- 
nel designated  by  the  State  department  of  health, 
when  he  is  assigned  to  such  a  department.  Other- 
wise he  will  present  his  reports  through  channels 
designated  by  the  board. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL.  HYGIENE  BOARD.       47 

(6)   The  follow-up   activities    invohed    in    section    •">-(6),   abo\f, 
include — 

(a)  A  search  for  information  as  to  the  use  made  of  facts 
submitted  to  law  enforcing  agencies  and  for  evi- 
dence as  to  the  enforcing  of  antivenereal  disease 
laws.  This  information  may  be  secured  by  direct 
investigation  by  the  a^ent  of  the  board,  or  from 
other  reliable  sources. 
(6)  The  preparation,  information,  or  organization  of  co- 
operative community  forces  that  may  assist  the 
local  or  State  authorities  in  the  enforcement  of  laws 
for  the  "  care  of  civilian  persons  whose  detention, 
isolation,  quarantine,  or  commitment  to  institu- 
tions may  be  found  necessary  for  the  protection 
of  the  military  and  naval  forces  of  the  United  States 
against  venereal  disease."  This  "  team  w^ork  "  may 
be  secured  through  such  measures  as  the  following : 

(1)  Alliances  with  already  established  commu- 

nity organizations  of  power  and  influence, 
such  as  the  chamber  of  commerce,  the  Ro- 
tary Club,  Parent-Teachers  Association, 
Mothers'  Club,  social  hygiene  societies,  the 
churches,  etc. 

(2)  Organization  of  special  associations  for  law 

enforcement. 

(c)  An  inquiry  into  the  conduct  of  individuals  subsequent 

to  their  medical  or  social  treatment  for  the  preven- 
tion of  venereal  diseases  and  the  eradication  of 
prostitution  involves  a  program  of  helpful,  unirri- 
tating  personal  inquiry  and  follow-up  contact  with 
the  individuals  concerned. 

(d)  The  inquiry  of  the  agent  of  the  board  concerning  the 

care  of  persons  while  they  are  quarantined,  isolated, 
or  committed  to  institutions  for  the  protection  of 
the  armed  military  and  naval  forces  of  the  United 
States.  This  inquiry  involves  a  critical  and  helpful 
inspection  or  examination  of  jails,  detention  homes 
and  hospitals,  clinics,  reformatories,  etc.,  first,  as 
to  the  existence  of  these  institutions ;  second,  as  to 
the  provisions  for  treatment  (medical  and  social), 
instruction  in  hygiene,  programs  of  recreation,  and 
training  and  preparation  for  productive  economic 
life  after  release  from  confinement. 


48       REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

III. 

The  success  and  the  efficiency  of  this  program,  as  applied  through 
cooperation  with  State  health  departments,  depend  upon  the  vigor- 
ous expert  support  of  the  chief  health  officer  in  each  State. 

To  drain  a  red-light  district  and  destro}?"  thereby  a  breeding  place 
of  S3^philis  and  gonorrhea  is'  as  logical  as  it  is  to  drain  a  swamp  and 
destroy  thereby  a  breeding  place  of  malaria  and  yellow  fever.  The 
obligations  and  responsibilities  of  the  health  officer  are  equally 
clear  in  both  of  these  tj^^pes  of  aggressive  intergroup  hygiene.  On 
the  one  hand,  he  must  secure  the  service  of  the  sanitary  engineer. 
On  the  other,  he  must  make  use  of  the  social  protective  agent — the 
worker,  the  court,  the  police. 


Tabulation  Showing  Pkogkam  of  Assignment  of  Bureaus  of  Pro- 
tective Social  Measures,     On  June  30,  1920. 

STATES  to  which  BUREAUS  OF  PROTECTIVE  SOCLiL  MEASURES  HAVE  BEEN 

ASSIGNED. 


1.  Arkansas. 

2.  Florida. 

3.  Georgia. 
i.  Kansas. 

5.  Louisiana. 


6.  Marylam]. 

7.  Missouri. 

8.  New  Hampshire. 

9.  New  Jersey. 

10.  North  Carolina. 


11.  Pennsylvania. 

12.  Tennessee. 

13.  Texas. 

14.  Virginia. 

15.  Washington. 


STATES  IN  WHICH  ASSIGNMENT  IS  IN  PROCESS. 


1,  Ohio. 

2,  South  Carolina. 

3,  Arizona. 


4.  Colorado. 

5.  New  Mexico. 

6.  Mississippi. 


T.  Utah. 
8.  Iowa. 


STATES   IN   WHICH  PLANS  FOR  BUREAUS   HAVE   NOT  YET  BEEN   PERFECTED. 


1.  California. 

2.  Illinois. 

3.  Kentucky. 

4.  Massachusetts. 

5.  New  York. 


6.  Oklahoma. 

7.  Rhode  Island. 

8.  Wisconsin. 

9.  Nebraska. 
10.  Michigan. 


11.  Alabama. 

12.  Connecticut. 

13.  District   of    Co- 

lumbia. 


STATES  IN  WHICH  BECAUSE  OF  THEIR  PRESENT  LIMITED  NAVAL  AND  MILI- 
TARY POPULATION  NO  ATTEMPT  HAS  BEEN  MADE  TO  ESTABLISH  BUREAUS. 


1.  Idaho. 

2.  Maine. 

3.  Minnesota. 

4.  Montana. 


5.  Nevada. 

6.  North  Dakota. 

7.  Oregon. 

8.  South  Dakota. 


9.  Vermont. 

10.  West  Virginia. 

11.  Wyoming, 

12.  Delaware. 


REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.       49 


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78       REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 
REPORT   OF   CASE  WORK  WITH  WOMEN  AND  GIRLS  BY  THE  FIELD  SERVICE. 


Table  1.  Number  of  cases. 
Table  2.  Color  of  new  cases. 
Table  3.  Men  involved  in  new  cases. 
Table  4.  Sex  relations  of  new  cases. 
Table  5,  Source  of  complaint  of  new 
cases. 


Table  6.  Reason  for  complaint  of  new 

cases. 
Table  7.  Disposition  of  new  cases. 
Table  8.  Disposition  of  continued  and 

reopened  cases. 
Table  9.  Total  dispositions. 
Table  10.  Special  data. 


Table  1. — Nmn'ber  of  cases,  fiscal  year  1919-^ 


Kind  of  case. 

Total. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total 

111,944 

2,979 

2,367 

2,478 

3,250 

2,229 

2,096 

1,967 

1,892 

1,703 

2,052 

1,895 

1,850 

7,351 

I  1,608 

1  117 

2,868 

902 

1,608 

117 

352 

758 

1,289 

106 

214 

659 

1,527 

98 

194 

663       630 

434 

1,.334 

94 

234 

529 
989 
157 
292 

524 

1,091 

96 

181 

623 

722 
108 
250 

562 

1,153 

104 

233 

545 

1,051 

113 

186 

522 

2,141 
143 
303 

1,268 
94 

237 

1  014 

Reopened 

'l22 

192 

1  The  continued  and  reopened  cases  are  not  totaled  because  these  are  the  same  cases  that  have  been 
counted  as  new  cases  in  some  previous  month. 

Table  2. — Color  of  new  cases,  fiscal  year  1919-20. 


Color. 

Total. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total 

7,351 

902 

758 

659 

663 

630 

434 

529 

524 

623 

562 

545 

522 

White 

5,866 

1,166 

236 

83 

780 

120 

2 

606 
82 
11 
59 

567 
58 
10 
24 

532 
105 
26 

464 
117 
49 

353 
62 
19 

432 
85 
12 

379 

131 

14 

473 
125 
25 

420 
132 
10 

459 
59 
27 

401 

Colored  . 

90 

Other.... 

31 

Not  reported 

Table  3. — Men  involved  in  neto  cases,  fiscal  year  1919-20. 


Men  involved. 

Total. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total 

7,351 

902 

758 

659 

663 

630 

434 

529 

524 

623 

562 

545 

522 

Soldier 

2,039 
986 

3,042 
673 
611 

214 
138 
429 
5 
116 

237 
179 
278 
18 
46 

206 

112 

234 

29 

78 

169 
71 

243 
75 

105 

181 

111 

222 

41 

75 

127 
68 

183 
25 
31 

172 
39 

223 
57 
38 

1.59 
50 
204 
106 
5 

204 
67 

217 
84 
51 

127 

27 

297 

68 

43 

111 

62 

260 

89 

23 

132 

Sailor 

62 

252 

None 

76 

Not  reported 

Table  4. — Sex  relations  of  neto  cases,  January  to  June,  1920.^ 


Sex  relations. 

Total. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total 

3,305 

529 

5I< 

623 

562 

545 

522 

Nnmhp.r  who  havp.  hafl  rp.lations 

2,385 

136 

406 

474 

466 

452 

451 

With  soldiers 

723 

295 

1,236 

131 

40 
32 
64 

84 

47 

144 

131 

182 

65 

227 

153 
20 

293 

142 

68 

242 

122 

With  sailors 

63 

With  chdlians 

266 

Number  who  have  never  had  relations 

Not  reported 

459 
461 

18 
375 

91 

27 

109 
40 

79 
17 

93 

69 
2 

1  This  data  not  available  previous  to  January,  1920. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       79 


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REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 


85 


Eed-Light  Districts  and  Their  Relationship  to  the  Army  and 

Navy. 

The  protective  social-measures  program  of  the  board  is  a  program 
of  search,  investigation,  formulation  of  reports,  and  presentation 
of  facts  for  the  construction  and  operation  of  programs  of  pro- 
tective social  measures  and  for  the  effective  enforcement  of  laws 
relating  thereto  by  duly  constituted  authorities  for  the  protection  of 
the  armed  military  and  naval  forces  of  the  United  States  against 
venereal  disease. 

The  board,  through  its  field  representatives,  has  been  active  in 
assisting  the  dul}^  constituted  authorities  to  close  red-light  districts 
in  the  vicinity  of  military  and  naval  stations. 

That  this  program  has  been  effective  is  demonstrated  by  the  three 
maps  reproduced  on  the  opposite  and  two  following  pages.  A  com- 
parison of  the  location  of  known  red-light  districts  with  the  location 
of  military  and  naval  establishments,  together  with  the  complements 
thereof  presented  in  another  section  of  this  report,  will  show  that  in 
five  cases  only  is  there  a  red-light  district  within  50  miles  of  an 
Army  or  Navy  station  with  a  complement  of  more  than  30  men. 

These  known  exceptions  are  as  follows : 


Red-light  district. 


Name  of  station. 


Nmnlier 
of  men. 


Distance 
apart. 


Des  Moines,  Iowa 
Harrisburg,  Pa . . . 

Paterson,  N.  J 

Savannah,  Ga 

Tacoma,  Wash . . . 


Camp  Dodge 

General    Hospital    No    31, 
Carlisle. 

Navy  yard,  Brooklyn 

Fort  Screven 

Camp  Lewis,  American  Lake 


2,694 
381 

3,576 

235 

1,925 


Miles. 


Case  Histories. 

Examples  of  cases  that  come  under  the  influence  of  the  protective 
social  measures  field  service  of  the  board: 


INDEX. 

1.  Edna;  venereal  disease;  food  handler  (sailors). 

2.  Mabel;  venereal  disease;  community  (soldier). 
8.  Mae;  venereal  disease  (soldier). 

4.  Bertha;  venereal  disease;  feeble-minded  (sailors). 

5.  Lena;  protective  (soldiers). 

6.  Sophie;  protective  (sailors). 

7.  Belle;  venereal  disease;  feeble-minded  (sailors). 

8.  Margaret ;  closed  dance  hall,  venereal  disease. 

9.  Esther ;  closed  dance  hall. 

10.  Helen;  venereal  disease;  feeble-minded  (civilian). 

11.  Rae ;  venereal  disease ;  drugs  (civilian). 

12.  Mildred ;  protective  (sailors). 

13.  Katherine;  male  venereal  disease  (civilian). 

14.  Hattie;  male  venereal  disease;  food  handler  (soldier). 


86        REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

Examples  of  types  of  service  rendered  by  women  agents  of  the 
board,  taken  from  individual  case  records,  are  cited  below,  showing 
in  various  cases  the  character  of  constructive  work  done  with  the 
girl,  with  the  family,  with  the  community,  and,  so  far  as  is  possible 
under  existing  conditions,  with  the  man  involved  in  the  case. 

Edna. — This  girl,  aged  18,  lived  in  a  furnished  "  light  housekeeping  "  room 
with  her  mother,  a  deserted  wife,  and  both  were  employed  packing  chocolates 
in  a  nationally  known  wholesale  grocery  plant.  The  girl  frequently  disappeared 
from  home  to  associate  with  sailors  on  Staten  Island,  remaining  away  several 
weeks  at  a  time,  and  after  one  of  these  absences  she  returned  infected  with 
•syphilis.  The  mother,  through  her  ignorance  and  poverty,  attempted  to  effect 
a  cure  by  means  of  patent  medicines,  permitting  the  girl  to  remain  at  her  work 
wrapping  chocolates  in  the  meantime.  When  found  by  agent  the  girl  was  in 
an  advanced  stage  of  infection,  a  serious  menace  to  her  associates  and  to  the 
food  she  was  handling. 

Agent  had  her  admitted  immediately  to  the  city  hospital,  and  her  mother  was 
directed  to  the  clinic  for  examination. 

The  case  was  reported  to  the  president  of  the  grocery  company,  who  evinced 
great  interest,  and  directed  that  routine  examinations  be  made  hereafter  on  all 
■employees  coming  in  contact  with  food. 

Mabel.— In  this  case,  a  bright,  responsive  girl  of  16  was  brought  up  in  an 
orphanage,  and  adopted  by  an  ultra-conservative  fanatical  type  of  elderly 
woman,  incapable  of  any  degree  of  understanding  of  her  charge.  The  girl's 
favorite  form  of  recreation  was  taking  long  walks  by  herself  after  the  dinner 
hour,  a  practice  permitted  by  the  otherwise  cautious  guardian.  A  chance 
acquaintance  with  a  discharged  soldier  developed  into  a  nightly  rendezvous,  and 
an  unlighted  park  afforded  the  opportunity. 

Agent's  attention  was  brought  to  the  case  when  the  girl,  infected  with  gonor- 
rhea, was  brought  into  court  by  the  guardian,  who  demanded  that  she  be  sent 
to  a  reformatory. 

The  agent's  recommendations,  however,  were  accepted  by  the  judge,  and  the 
girl,  only  slightly  infected,  was  placed  under  treatment  until  entirely  cured ; 
she  was  then  sent  to  the  home  of  a  sympathetic  young  woman  in  a  small  town, 
to  work  as  mother's  helper.  Our  last  reports  show  that  the  girl  has  remained 
almost  a  year  in  this  position  and  that  she  is  happy  and  contented. 

The  matter  of  the  unlighted  parks  was  taken  up  with  the  mayor  and  the  park 
commissioners,  which  resulted  in  provision  for  additional  lighting  and  policing. 
Mae. — We  have  in  this  case  a  type  of  hardened  prostitute,  infected,  a  con- 
tinuous source  of  danger  to  the  community.  A  soldier  sent  to  the  venereal  disease 
hospital  named  the  girl  as  the  source  of  his  infection,  and  agent  took  immediate 
steps  to  have  the  girl  apprehended  and  examined.  A  careful  study  of  condi- 
tions did  not  disclose  evidence  that  would  warrant  agent  in  giving  her  a 
"  chance  "  on  probation,  and  upon  agent's  recommendation,  she  was  sentenced 
to  the  State  reformatory,  where  treatment  and  training  will  be  given,  covering 
a  period  of  years. 

Bertha. — This  girl  presents  a  type  of  feeble-mindedness  that  is  frequently 
the  victim  of  exploitation.  At  22  she  possessed  a  mental  age  of  8.  Her  school 
record  showed  that  she  was  permitted  to  stay  in  the  third  grade  until  she  was 
17.  A  few  attempts  at  various  occupations  followed,  but  she  was  not  kept 
longer  than  a  day  or  two  in  each  position.  Then  she  commenced  to  run  away 
from  home.  The  last  time  her  father,  a  respectable  clerk,  found  her,  she  was 
living  in  a  room  over  a  stable  with  an  Italian  chauffeur  who  brought  sailors 


EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       87 

to  lier  every  night.  The  Italian  collected  the  money  from  the  sailors.  The  girl 
was  arrested  on  her  father's  complaint  and  sentenced  to  90  days  in  the  county 
jail. 

Agent  became  interested  in  the  case  and  secured  mental  and  physical  exami- 
nations, which  disclosed  her  hopeless  state  of  feeble-mindedness  and  a  four  plus 
Wassermann  reaction.  The  girl  was  removed  to  the  State  institution  for  the 
feeble-minded,  where  she  will  be  safely  kept  from  the  reach  of  the  exploiter,  and, 
as  a  protection  to  the  community. 

Lena. — This  is  the  case  of  an  attractive  little  17-year-old  girl,  living  alone 
and  working  in  questionable  restaurants  near  a  large  camp.  The  military 
police  requested  her  detention  for  examination,  as  she  was  continuously  seen  in 
the  company  of  soldiers.  Examination  showed  the  girl  to  be  free  from  infection, 
but  it  brought  her  to  the  attention  of  agent.  She  told  agent  that  her  family 
was  scattered  and  indifferent  and  that  no  one  ever  took  any  interest  in  her. 
A  soldier  had  promised  to  marry  her,  but  had  left  her  after  persuading  her  to 
have  immoral  relations  with  him,  and  she  was  discouraged  and  ready  to  embark 
on  a  life  of  prostitution. 

Agent  was  able  to  gain  this  girl's  confidence.  She  went  to  live  in  a  home 
agent  selected  for  her,  worked  steadily  and  attended  church  at  agent's  sugges- 
tion, helped  and  encouraged  by  her  sympathy  and  friendship. 

In  the  rehabilitation  of  tliis  girl,  agent  was  not  only  helping  an  individual 
but  she  was  saving  the  camp  and  community  from  the  inestimable  cost  of  an 
additional  prostitute. 

Sophie. — A  parallel  case  is  found  in  this  bright  little  Polish  girl  of  17, 
whose  questionable  conduct  with  sailors  caused  the  chief  of  police  to  refer  her 
to  agent.  Agent  found  an  intelligent,  responsive  girl  with  marked  traits  of 
leadership.  The  Polish  home  she  came  from  did  not  fulfill  all  of  her  American- 
acquired  ideals,  and  her  work  in  a  Polish  restaurant  did  not  absorb  an  appre- 
ciable amount  of  her  youthful  energy.  She  "  hung  around  "  other  restaurants 
talking  to  sailors. 

Agent  found  that  the  girl  had  committed  no  wrong,  but  that  she  was  in 
serious  danger  if  she  were  to  be  left  to  her  own  resources.  She  responded 
readily  to  agent's  suggestion  to  join  a  girl's  club,  and  when  it  was  found  that 
the  Neighborhood  Settlement  House  afforded  no  club  to  which  she  was  eligible, 
at  agent's  suggestion  the  girl  organized  her  own  friends  and  brought  them  into 
the  settlement.  Our  last  report  shows  that  her  club  had  more  than  doubled  its 
membership. 

In  cases  like  these  the  keen  sympathy  and  understanding  of  trained  workers 
effect  what  rigid  police  methods  fail  to  touch. 

Belle. — This  is  the  instance  of  a  girl  of  respectable  parentage  who  got 
beyond  the  control  of  her  family.  She  became  infected  with  chronic  gonorrhea, 
and  while  detained  in  the  city  hospital  she  freely  discussed  her  fondness  for 
sailors  and  her  plans  to  don  a  uniform  and  board  a  ship. 

Agent  had  the  girl  placed  under  mental  observation,  which  proved  her  to  be 
feeble-minded,  and  she  was  committed  to  a  State  institution,  where  she  will  be 
safely  kept  away  from  danger  to  herself  and  to  the  community. 

Margaret. — This  is  the  case  of  a  21-year-old  girl,  having  a  high-school  edu- 
cation and  possessed  of  some  natural  attainments.  The  girl  was  a  stenog- 
rapher, but  later  became  an  "  instructor  "  in  a  closed  dance  hall  at  the  alluring 
salary  of  $45  a  week. 

The  temptations  to  which  girls  are  exposed  in  the  closed  dance  halls  proved 
too  much  for  her,  and  she  was  arrested  when  she  was  found  in  a  compromising 
position  with  two  soldiers  in  a  park. 


88       REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD. 

Esther. — This  girl  was  brought  up  on  a  ranch,  and  the  agent  found  her  in 
tlie  city  deserting  domestic  service  for  tlie  glamour  of  the  closed  dance  hall. 
An  intoxicated  sailor  afforded  an  opportunity  for  grand  larceny,  and  her  arrest 
followed. 

Probably  one  of  the  most  serious  problems  our  agents  encounter  in  rehabilita- 
tion work  is  trying  to  compete  in  honest  work  with  the  salaries,  fascination, 
and  excitement  of  the  closed  dance  halls;  and  the  fact  that  many  of  the 
so-called  instructors  eventually  come  under  the  agent's  notice  and  care  is  evi- 
dence of  their  vicious  influence  on  the  community.  It  is  fortunate  that  this 
type  of  dance  hall  is  confined  to  a  few  cities. 

In  many  cases  the  women  and  girls  who  come  under  our  agents^ 
observation  have  not  been  involved  with  sailors  or  soldiers,  but  they 
have  been  directly  involved  with  civilians.  By  the  very  nature  of 
their  offenses  and  their  condition  they  are  a  potential  menace  to  the 
armed  forces  in  their  vicinity,  and  it  is  an  important  part  of  our 
agents'  duties  to  afford  such  civilian  offenders  as  careful  and  inter- 
ested attention  as  the  girls  who  have  been  in  direct  contact  with 
Liniformed  men.  Agents  are  frequently  called  into  conference  on 
community  matters  affecting  problems  of  delinquency,  and  their 
advice  is  sought  by  all  organizations  having  a  girl  problem.  A  num- 
ber of  communities  have  been  exceedingly  cooperative  and  anxious  to 
avail  themselves  of  the  cooperation  of  our  workers. 

The  following  cases  present  types  of  civilian  and  community  prob- 
lems handled  by  agents : 

Helen. — In  this  case  the  girl,  a  foundling,  spent  18  years  of  her  life  in  a 
church  institution  under  the  strict  surveillance  of  the  instructors.  When  she 
was  placed  out  in  a  housework  position  and  upon  her  own  resources  there  was 
a  marked  change  in  her  conduct.  No  responsibility  could  be  placed  in  her ;  her 
work  grew  steadily  poorer ;  and  she  was  not  able  to  retain  a  position.  After 
a  year  or  two  of  failures  she  was  taken  from  housework  and  placed  in  a 
factory,  where  she  was  able  to  do  simple  operating.  Life  in  furnished  rooms 
brought  with  it  the  usual  loneliness,  and  seeking  for  pleasure  the  girl  became 
involved  with  the  worst  type  of  Greek  candy-store  keepers. 

Agent  found  her  too  ill  to  work,  in  the  secondary  stage  of  syphilis,  but  still 
attempting  to  ply  her  trade  at  night.  The  girl  was  admitted  to  the  city  hos- 
pital for  treatment  and  placed  under  mental  observation.  She  was  committed 
to  the  State  institution  for  the  feeble-minded  to  remain  during  her  child- 
bearing  years. 

Rae. — This  is  the  case  of  a  girl  of  23,  brought  up  in  a  good  home  and 
graduated  from  high  school.  An  unfortunate  marriage  with  a  dissipated  man 
who  infected  her  with  syphilis  resulted  in  a  separation.  Following  the  separa- 
tion, invalidism  from  an  accident  was  the  direct  cause  of  an  excessive  use  of 
drugs,  and  agent  came  into  the  case  after  the  girl  had  been  brought  Into  court 
for  violation  of  the  State  drug  law. 

Agent  persuaded  the  girl  to  undergo  treatment  for  drug  addiction,  which  she 
consented  to  do,  and  the  case  is  closed  with  the  girl  returned  from  the  hospital, 
living  with  her  sister,  and  entering  upon  a  course  in  the  local  business  college. 

Mildred. — Tliis  is  the  instance  of  a  girl  of  17,  of  youthful  spirits  and  energy, 
living  alone  with  a  very  strict  father.  She  had  been  returned  by  the  Trav'elers' 
Aid  Society  after  an  attempt  to  change  her  lot  by  running  away,  and  on  one  occa- 
sion her  father  had  had  her  arrested  for  attending  a  dance.    They  lived  in  con- 


REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD.       89 

staiit  discord,  due  to  the  man's  strict  discipline  of  her,  and  the  girl's  struggle 
for  self-expression.  When  agent  caiue  into  the  case  the  father  was  making  an 
effort  to  have  tlie  girl  committed  to  a  reformatorj'. 

Agent  was  successful  in  a  plan  to  permit  the  girl  to  attend  community  dances, 
entertain  her  sailor  friends  in  her  home,  and  to  interest  her  father  in  her 
friends. 

Whenever  the  hiws  permit,  agents  make  every  effort  to  have  the 
male  offender  accorded  the  treatment  meted  out  to  the  woman  offend- 
ers. Communities  providing  facilities  for  physical  examinations  are 
steadily  increasing,  and  the  man  is  also  prosecuted  if  sufficient  evi- 
dence can  be  secured. 

The  following  illustrate  cases  in  which  man  offenders  have  been 
dealt  with  by  agents  of  the  board: 

KatJierine. — In  this  case  a  girl  of  the  hardened  prostitute  type  lived  in  the 
United  States  but  worked  each  day  in  the  "  cribs  "  attached  to  the  barrooms  in 
a  Mexican  town  across  the  border.  The  barkeeper  who  secured  the  post  for  her 
paid  her  daily  license  and  collected  her  earnings,  and  then,  because  they  were 
constantly  crossing  and  recrossing  the  border,  as  a  precautionary  measure,  he 
married  her. 

When  agent  came  into  the  case  she  found  the  girl  a  drug  addict  and  infected 
with  syphilis,  and  she  was  placed  in  the  city  hospital. 

The  man  was  not  permitted  to  escape,  however,  and  a  charge  of  violation  of 
the  Mann  Act  has  been  brought  against  him  for  his  activities  prior  to  mar- 
riage to  the  woman.    At  the  last  report  he  was  awaiting  trial  in  the  county  jail. 

Hattie. — In  this  case  a  17-year-old  girl  lived  with  her  father  in  a  small  town 
near  an  arsenal.  The  neighbors  complained  about  tlie  number  of  soldiers 
and  other  men  going  in  and  out  of  their  house  and  the  district  attorney  had  the 
girl  brought  before  him.  She  told  a  sordid  story  of  immorality  and  incest  dat- 
ing back  too  early  for  her  to  remember  when  it  all  began.  Her  father  liad  done 
no  work  for  years  and  lived  on  her  illicit  earnings.  The  girl  had  an  older  sister 
who  had  left  her  husband  to  live  with  a  Negro  consort,  and  the  girl  also  admitted 
relations  with  her  brother-in-law  and  with  the  Negro.  A  Greek  restaurant  was 
named  as  a  place  regularly  visited  by  the  women.  Further  investigation  in- 
volved an  11-year-old  daughter  of  the  married  sister,  who  had  also  been  ex- 
ploited by  the  degenerate  members  of  this  family.  It  is  almost  unnecessary  to 
add  that  every  one  of  the  persons  who  figured  in  this  case  were  actively  infected 
with  venereal  disease. 

Sentences  in  reformatories  were  given  the  two  women,  while  the  father  of 
the  girls,  the  son-in-law  and  husband,  and  the  Negro  consort  received  sentences 
of  15  years  each  in  State  prison  on  charges  of  rape  and  incest. 

The  restaurant  keeper  was  ordered  examined  and  found  to  be  in  an  active 
stage  of  syphilis,  and  his  restaurant  was  closed  by  the  district  attorney  and  the 
man  ordered  to  take  treatment. 

The  work  of  agents  of  the  board  is  not  confined  to  work  with  in- 
dividuals. While  it  is  important  to  have  appeals  from  the  pulpit 
and  from  women's  organizations  and  civic  associations  when  the 
need  is  felt  for  new  machinery  in  the  community,  it  is  infinitely  more 
forceful  to  present  an  appeal  based  on  actual  experience.  When  a 
worker  can  show  by  real  histories  the  necessity  for  making  provision 
for  meeting  the  problems  and  can  speak  from  actual  experience  of 
unsatisfactory  conditions  in  the  community,  the  force  of  the  appeal 
is  going  to  be  felt. 


90       REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

In  a  recent  investigation  of  histories  of  a  number  of  unmarried 
mothers  in  an  eastern  city  an  appreciable  number  of  the  girls  named 
a  city  park  as  the  place  where  they  had  practiced  immorality. 
Agent's  investigation  brought  forth  the  facts  that  the  park  was  in 
an  isolated  part  of  the  city,  and  that  it  was  poorly  lighted  and  in- 
sufficiently policed,  facts  that  were  obviously  known  to  an  indifferent 
community.  When,  however,  she  was  able  to  state  the  number  of 
girls  bearing  illegitimate  children  on  account  of  opportunities  pro- 
vided in  that  park,  and  the  girls  and  their  babies,  could  be  produced, 
it  was  not  difficult  to  arouse  the  community  to  concerted  action  to 
remedy  the  evil  with  a  power  and  force  that  unlimited  agitation 
against  an  unlighted  park  fer  se  never  could  have  brought  forth. 

An  agent  having  the  actual  disposition  of  a  number  of  feeble- 
minded girls,  with  no  facilities  for  giving  them  the  custodial  care, 
without  which  neither  they  nor  the  community  can  be  safe,  can 
make  the  most  direct  appeal  for  an  institution  for  the  feeble-minded. 

Through  intensive  case-work  methods  all  of  the  facts  of  a  delin- 
quent girl's  history  are  brought  out,  and  a  pretty  fair  estimate  of 
community  weaknesses  can  be  observed  in  the  summary  of  the 
records.  In  a  southern  city  it  was  found  that  a  great  number  of 
young  girls  brought  into  court  on  various  charges  of  delinquency 
had  been  employed  in  candy  factories.  The  agent  made  a  study  of 
the  connection  between  that  sort  of  employment  and  the  offense,  and 
her  investigation  showed  that  the  low  wages  prevailing  in  the  candy 
trades  forced  the  unskilled  worker  to  supplement  her  earnings  by 
acts  of  prostitution.  Her  findings  were  that  employment  in  candy 
factories  in  that  community  would  be  classified  as  one  of  the  dan- 
gerous trades  for  young  women,  at  least  until  compensation  had 
been  adjusted  to  permit  of  a  living  wage. 

Evidence  of  the  social  "  weak  spots  "  in  a  community  are  repeat- 
edly forced  upon  the  attention  of  agents  of  the  board.  They  know 
from  carefully  compiled  case  records  of  delinquent  girls  just  how 
vicious  an  influence  is  the  average  soft-drink  parlor  and  the  shoe- 
shining  parlor  conducted  by  Greeks;  the  public  taxi,  with  its  pro- 
curing chauffeur ;  the  unsupervised  dance  hall  and  the  indecent  bur- 
lesque show.  They  are  able  to  present  these  cases  with  telling  force  in 
a  campaign  to  exterminate  the  sources  of  prostitution. 

By  carefully  compiled  studies  of  court  sentences  showing  the  dis- 
position of  women's  cases  the  pressure  of  public  opinion  has  been 
brought  to  bear  by  agents  on  the  importance  of  provision  for  mental 
and  physical  examinations  of  offenders,  of  facilities  for  custodial 
care  of  the  mentally  unsound,  and  of  training  and  education  for 
those  competent  to  profit  by  it,  and  they  have  helped  to  expose  the 
utter  futility  of  the  fining  system — a  system  licensing  and  tolerating 
prostitution,  not  tending  to  eliminate  or  control  it. 


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REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       91 

Monthly  text  reports  received  in  Washington  show  the  far-reaching 
influence  of  agents  in  the  community  and  the  wide  variety  of  com- 
munity problems  they  are  called  upon  to  meet. 

On  the  prevention  of  delinquency  side  an  agent  in  a  New  England 
city  recently  made  a  survey  of  recreational  opportunities  for  girls, 
showing  the  lack  of  such  opportunities  for  girls  between  tlSe  ages 
of  18  and  25.  Carefully  selected  data  of  this  sort  forms  the  basis 
of  a  campaign  for  additional  recreational  facilities. 

In  the  hope  of  securing  publicity  in  prison  conditions  and  intelli- 
gent interest  in  the  management  of  public  institutions  in  a  Middle 
West  city  a  study  was  made  of  conditions  in  three  municipal  houses 
of  detention,  and  the  report  was  presented  to  the  police  committee 
of  a  civic  organization. 

An  agent  in  the  Southwest  instituted  a  school  for  women  confined 
in  a  venereal  disease  ward  of  the  city  hospital.  The  work  was 
started  primarily  for  the  education  of  the  women,  but  it  has  stimu- 
lated an  interest  in  something  besides  the  continuous  recital  of  their 
experiences  to  each  other.  The  moral  effect  upon  the  women,  making 
them  feel — as  it  has — that  their  welfare  was  being  considered,  and 
that  they  were  not  merely  consigned  to  isolation  and  forgotten,  has 
been  pronounced. 

The  foregoing  is  typical  of  the  varied  activities  of  the  field  agents, 
but  results  are  necessarily  intangible  and  can  not  be  set  forth  in 
figures. 

Geographic  distHhution  of  the  sources  of  infection  of  lOfiOO  sol- 
diers reporting  to  the  Surgeon  General  of  the  Army.  {See  map 
opposite;  also  Tdble^  p.  Ji-8.) 

This  distribution  demonstrates  the  fact  that  every  State  is  in- 
volved, even  in  the  consideration  of  this  relatively  small  number  of  in- 
fections, and  that  prostitution  and  venereal  disease  are  matters  of 
compelling  national  importance  as  well  as  serious  local  concern.^ 

This  demonstration  would  be  strikingly  emphasized  if  there  could 
be  added  to  it  the  geographical  distribution  of  the  sources  of  infec- 
tion of  21,000  sailors  reported  to  the  Surgeon  General  of  the  Navy,  a 
very  large  proportion  of  which  was  contracted  in  the  United  States. 

This  demonstration  is  concerned  with  the  distribution  of  sources 
of  infections  of  soldiers.  It  is  obvious  that  the  protection  of  the 
civilian  population  is  a  matter  of  very  considerably  greater  im- 
portance, a  fact  which  is  established  beyond  question  by  the  reporting 
of  326,000  cases  of  infection  to  the  State  commissioners  of  health 
this  last  year  and  by  the  estimate  that  there  were  over  1,500,000  cases 
of  gonorrhea,  syphilis,  and  chancroid  in  the  civil  population  of  con- 
tinental United  States  during  this  period. 

1  The  numbers  of  cases  reported  as  infected  in  different  cities  are  largely  dependent 
upon  tlie  presence  of  bodies  of  troops  in  the  vicinity,  and  therefore  can  not  be  taken  as 
necessarily  indicating  the  respective  vice  conditions  in  the  communities. 


92       EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD» 


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94       EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 


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REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       95 

Venereal  diseases  in  the  Army — Numher  and  rates  of  admission  of  enlisted  men 
in  the  United  States,  fiscal  year  1919-20. 


Period. 


July  1, 1919,  to  Dec.  31, 1919 
Jan.  1,  1920,  to  June  30, 1920 
July  1, 1919,  to  June  30,  1920 


Number 

cases 
reported. 


10, 148 
3,891 
14,039 


Mean 

strength 

of  troops 

reported 

on. 


167,530 
158,570 
163,050 


Rate  per 
1,000  per 
annum. 


121.15 
49.08 
86.10 


For  the  period  July  1,  1919,  to  December  31,  1919,  the  figures  used  are  the  final  corrected  figures  used 
by  the  Surgeon  General's  Office  for  their  annual  report. 

For  the  period  January  1, 1920,  to  June  30, 1920,  the  figures  used  are  obtained  from  the  weekly  mail  reports 
which  are  the  most  reliable  reports  for  this  period  as  yet  available. 

Venereal  diseases  in  the  Navy — Numier  and  rates  of  admission  for  the  entire 
Navy,  fiscal  year  1919-20. 


Period. 


Number 

cases 
reported. 


Mean 
comple- 
ment. 


Ratelper 
1,000  per 
annmn. 


July  1, 1919,  to  Dec.  31,  1919, 
Jan.  1,  1920,  to  June  30, 1920 
July  1,  1919,  to  June  30, 1920 


14,396 
6,957 
21,353 


201,554 
133,343 

167,448 


142. 8.5 
104. 35 
127.52 


The  figures  used  for  the  first  six  months  of  1920  are  exact.  The  figures  used  for  the  last  six  months  of 
1919  represent  the  uncorrected  figures  received  from  month  to  month.  They  include  some  cases  on  which 
the  diagnosis  was  undoubtedly  changed  afterwards  and  consequently  the  number  is  greater  than  the 
actual  number  of  cases. 

Reports  received  from  fi.eld  representatives. 

Total    number   of   reports   received   from   supervisors   and   field   agents 

(men  and  women) 1,847 

Total  number  of  reports   received   from  confidential   agents    (men  and 

women) 832 

Tabulation   showing   activities   in   "  The   preparation   of   systematic   accurate 
reports  covering  the  activities  of  the  protective  social  agents  of  the  board." 

KEPOKTS   OF   SUPEKVISOKS   AND   FIELD   AGENTS    (MEN). 


Total  number  of  agents  making  reports 21 

Total  number  of  reports  made 1,  257 

Total  number  of  cities  and  towns  reported  on 351 

Total   number  of  reports   summarized   and   submitted  to   law-enforcing 

agencies 1,  2.57 

It  will  be  interesting  to  note  that  these  21  agents,  in  reporting  on  351  different 
cities,  expressed  their  judgment  of  the  effectiveness  of  the  protective  social 
measures  program,  as  follows :  Excellent,  16 ;  good,  624 ;  fair,  320 ;  bad,  170 ; 
and  urgent,  20. 

A  study  of  the  progress  ot  the  program  of  protective  social  measures  in  those 
351  cities  induced  the  following  expression  of  judgment  from  21  agents :  22 
cities,  nrarked  improvement ;  67,  fair  improvement ;  45,  slight  improvement ; 
18,  no  appreciable  change ;  23,  slight  retrogression ;  6,  considerable  retrogres- 
sion ;  and  2,  marked  retrogression. 


96        EEPORT  U.  S.  INTERDEPARTMEIsrTAL  SOCIAL  HYGIENE  BOARD. 

EEPORTS    OF    CONFIDENTIAL   AGENTS     (MEN    AND    WOMEN). 

Total  number  of  agents  making  reports ^19 

Total  number  of  reports  made 832 

Total  number  of  cities  and  towns  reported  on '. 366 

Total  number  of  reports  typed  for  sending  to  law-enforcing  agencies 832 

Total  number  of  sheets  of  report  material  sent  for  action  by  law-enforc- 
ing agencies' 5,  824 

It  will  be  interesting  to  note  that  these  19  agents  in  reporting  on  366  different 
cities  expressed  their  judgment  of  the  general  vice  conditions  therein  as  follows : 
Conditions — excellent,  12 ;  good,  157 ;  fair,  75 ;  and  bad,  122. 

BECOED    OF    LAW    ENFORCEMENT    STIMULATED    BY    EVIDENCE    SUBMITTED    TO    LAW 
ENFOECING    AGENCIES    THEOUGH   EEPEESENTATIVES    OF    THE    BOAED. 

1.  Number  of  red  light  districts  closed 18 

2.  Number  of  houses  of  prostitution  closed  in  these  18  districts 214 

3.  Number  of  inmates  in  these  214  houses  at  time  of  closing 703 

4.  Number  of  houses  of  prostitution  closed  outside  of  red  light  districts  719 

5.  Total  number  of  houses  of  prostitution  closed  within  and  without 

red  light  districts  (total  of  1  and  4) 933 

6.  Number  of  places  in  which  programs  of  prostitution  other  than  in 

open  houses  of  prostitution  have  been  suppressed 646 

7.  Number  of  districts  or  sections  of  cities  placed  "  off  limits  "  to 

soldiers  or  sailors  by  military  and  naval  authorities 55 

8.  Number  of  men  arrested  by  law  enforcing  agencies  for  violation  of 

antiprostitution  laws  or  ordinances 10, 129 

9.  Number  of  open  houses  of  prostitution  observed  by  the  confidential 

agents  of  the  board 1,  043 

10.  Total  number  of  prostitutes  observed  by  the  confidential  agents  of 

the  board   (white,  13,677;  colored,  3,324) - 17,001 

COMMITTEES  FORMED. 

1.  Number  of  committees   or  organizations   formed  or   stimulated   to 

action  for  the  furtherance  of  the  program 260 

Tabulation  shotcing  red  light  districts  wMch  ivere  closed  through  the  assistance 
of  the  board's  field  representatives ;  giving  the  number  of  houses  and  inmates 
thereof. 


City. 

Number 
of  houses. 

Number 
of  in- 
mates. 

City. 

Number 
of  houses. 

Number 
of  in- 
mates. 

1.  Wheeling,  \V.  Va 

40 

40 

34 

17 

15 

12 

9 

7 

6 

6 

212 
75 
60 
68 
35 
72 
32 
15 
13 
24 

11.  Columbus,  N.  Mex 

12.  Bethlehem,  Pa 

5 

.    4 
4 
4 
3 
3 
3 
2 

25 

2.  Key  West,  Fla 

8 

3.  Baltimore,  Md 

13.  Park  City,  Utah 

20 

4.  Columbus,  Ga 

14.  West  Palm. Beach,  Fla.... 

15.  Carlisle,  Pa 

15 

5.  Easton,  Pa  ... 

6 

16.  Hazleton,  Pa 

8 

7.  Athens,  Ga 

17.  Pottsville,  Pa 

18.  Stroudsburg,  Pa 

50 

8.  Columbia,  Pa      

1 

9.  Monessan,  Pa 

10.  Niagara  Falls,  N.  Y 

Total 

214 

703 

1  Not  more  than  15  confidential  agents  were  employed  at  any  one  time. 


REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL.  HYGIENE  BOARD.       97 


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98       REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

Tabulations  showing  red  light  districts  discovered  by  the  board's  agents  which 
remained  open  on  June  30,  1920. 


City. 


Albany,  Ga 

Bangor,  Me 

Bath,  Me 

Beaumont,  Tex . . . . 

Biloxi,  Miss 

Brownwood,  Tex. . . 

Cairo,  111 

Carson  City,  Nev.i.. 
Corpus  Chfisti,  Tex. 
Cumberland,  Md. . . 
Des  Moines,  Iowa... 

Dodge,  Kans 

Erie,  Pa 

Florence,  S.  C 

Gallup,  N.  Mex 

Galveston,  Tex 

Goldsboro,  N.  C 

Hagerstown,  Md 

Harrisburg,  Pa , 

Jackson,  Miss 

Jactsonville,  Fla 

Keokuk,  Iowa 

Kinston,  N.  C 

Lebanon,  Pa 

Mason  City,  Iowa 


Number 

of 
houses. 


7 
5 

37 
15 

4 

11 

13 

40 

5 

16 

3 

9 

9 

41 

Number 

of 
inmates. 


City. 


Number 

of 
houses. 


Memphis,  Tenn 

Muscatine,  Iowa 

Nashville,  Tenn 

Natchez,  Miss 

Old  Forge,  Pa 

Ottumwa,  Iowa 

Paterson,  N.J 

Pensacola,  Fla 

Peoria,  111 

Port  Arthur,  Tex 

Raleigh,  N.  C 

Reno,  Nev.i 

Savannah,  Ga 

Scranton,  Pa , 

Sioux  City,  Iowa , 

Springfield,  111 

Tacoma,  Wash , 

Tampa,  Fla 

Tonopah,  Nev.i 

Troy,  N.  Y 

Vicitsburg,  Miss 

Wilson,  N.  C 

West  Palm  Beach,  Fla. 

Total 


Number. 

of 
inm.ates. 


10 

8 
45 
27 
13 
37 
12 
18 
18 
15 
10 


40 
15 
42 
95 
38 
15 


1,016 


1  Information  secured  by  correspondence.    Number  of  houses  and  inmates  unknown. 

Program  for  Assistance  of  States  in  Maintainijstg  Civilian  Per- 
sons Whose  Detention,  Isolation,  Quarantine,  or  Commitment 
TO  Institutions  Has  Been  Found  Necessary  for  the  Protection 
OF  THE  Military  and  Naval  Forces  of  the  United  States 
Against  Venereal  Disease. 

In  continuation  of  the  policy  adopted  last  year  the  Secretary  of 
War  and  the  Secretary  of  the  Navy  authorized  the  Interdepartmental 
Social  Hygiene  Board  this  year  to  give  further  assistance  to  the 
States  in  the  maintenance,  subsistence,  and  treatment  of  civilian  per- 
sons with  venereal  disease  who  were  a  menace  to  soldiers  or  sailors. 

In  July,  1919,  the  boai'd  adopted  the  following  regulations  relative 
to  this  type  of  assistance: 

GENEEAL  REGULATIONS  GO\'ERNING  APPEOPRIATIONS  FROM  THE  UNITED  STATES  INTER- 
DEPARTMENTAL SOCIAL  HYGIENE  BOARD  FOR  ASSISTANCE  OF  INSTITUTIONS  IN  THE 
MAINTENANCE  OF  VENEREALLY  INFECTED  PATIENTS. 

The  Interdepartmental  Social  Hygiene  Board  at  a  meeting  held  on  July  22 
decided  "  that  in  general,  no  further  appropriations  will  be  made  for  the 
assistance  of  institutions  in  the  maintenance  of  venereally  infected  patients 
under  the  provisions  of  sections  2  and  5  of  the  Chamberlain-Kahn  bill  unless 
satisfactory  assurance  is  secured  (a)  that  the  institution  concerned  is  a  perma- 
nent establishment,  (&)  that  it  cares  for  persons  infected  with  venereal  dis- 
ease who,  if  free,  would  be  a  menace  to  soldiers  and  sailors,  (c)  that  a 
temporary  emergency  exists  making  financial  help  from  the  board  an  imperative 
necessity,  (d)  that  the  board  of  health  of  the  State  in  which  the  institution 
making  application  is  located  urgently  recommends  that  the  board  give  the  tempo- 


KEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.       99 

rary  financial  assistance  requested,  (e)  that  tlie  allowance  for  per  capita  cost  per 
diem  for  maintenance  will  not  exceed  the  actual  cost  (maximum  $1.50)  of  such 
maintenance,  and  that  maintenance  will  not  include  rent,  insurance  overhead, 
or  other  items  of  maintenance  that  do  not  vary  with  the  number  of  patients 
cared  for  each  day  by  the  institution,  and  (/)  that  the  institution  concerned 
provides  a  wise  policy  of  medical  treatment,  hygienic  instruction,  vocational 
education,  recreation,  and  social  rehabilitation  for  its  inmates." 

Between  June  30,  1919,  and  July  1,  1920,  the  board,  acting  under 
this  authority,  gave  assistance  for  these  purposes  to  the  following 
institutions  and  for  the  following  amounts : 

1.  State  Training  School  for  Girls,  Birmingham,  Ala .$1,000.00 

2.  Ward  L,  San  Francisco  Hospital,  San  Francisco,  Calif 8,  007.  00 

3.  Jefferson  County  Institutions,  Louisville,  Ky 3,  993.  25 

4.  Mercy  Hospital,  venereal  disease  detention  ward,  Baltimore,  Md_  100.  00 

5.  State  Department  of  Health  Hospital  No.  1,  Baltimore,  Md 2, 134. 11 

6.  Fairmount  Hospital,  Kalamazoo,  Mich 11,  077.  27 

7.  Female  Detention  Ward,  St.  Louis  City  Hospital,  St.  Louis,  Mo-  1, 233.  84 

8.  Florence  Crittenton  League,  New  York,  N.  Y 349.  50 

9.  State  Home  and  Industrial  School  for  Girls  and  Women,  Samar- 

cand,  N.  C 48,  929.  43 

10.  Akron  Welfare  Home  for  Women,  Akron,  Ohio 1,  860.  73 

11.  Cincinnati  General  Hospital,  Cincinnati,  Ohio 5,934.00 

12.  Anna  Finstrom  Detention  Hospital,  Columbia,  S.  C 3,  739.  50 

13.  Shelby  Hospital,  Memphis,  Tenn 4,  658.  37 

14.  Chattanooga  Venereal  Quarantine  Hospital,  Chattanooga,  Tenn_  7,  200.  00 

15.  Texas  Girls'  Training  School,  Gainesville,  Tex 4, 136.  99 

16.  City  Hospital  and  City  Home,  Norfolk,  Va 1,  945.  47 

Total    paid 106,  299.  46 

STJMMABY. 

Average  number  of  venereally  infected  persons  in   above  institutions 

monthly  during  period  in  which  assistance  was  given 11,  493 

Actual  total  number  of  days  maintenance,  treatment  and  subsistence 

given  by  above  institutions 96,  842 

Average  per  capita  cost  per  day $1. 11 

Assistance  of  this  type  will  no  longer  be  permitted  after  July  1, 
1920,  in  pursuance  with  a  provision  attached  by  Congress  to  this 
appropriation  last  June.    This  provision  reads  as  follows : 

Provided,  That  no  part  of  these  sums  shall  be  expended  in  assisting  reforma- 
tories, detention  homes,  hospitals,  or  other  similar  institutions  in  the  mainte- 
nance of  venereally  infected  persons. 

An  investigation  has  been  authorized  by  the  Interdepartmental 
Social  Hygiene  Board  for  the  purpose  of  evaluating  the  investment 
made  by  the  Government  during  the  war  through  the  Commission  on 
Training  Camp  Activities  for  the  construction,  repair,  and  equipment 
of  such  institutions  as  these.  This  investigation  will  further  evaluate 
investments  that  were  made  last  year  and  this  year  for  the  assistance 


100     REPORT  U.  S.  INTERDEPAETME^TTAL,  SOCIAL.  HYGIENE  BOARD. 

of  such  institutions  in  the  maintenance  of  venereally  infected  inmates. 
It  is  expected  that  these  investigations  will  secure  material  for  a  re- 
port this  coming  year.  (See  Appendix  for  regulations  and  applica- 
tion form  in  connection  with  this  appropriation. ) 

Eeport  on  Medical  Measures. 

COOPEKATION  OF  DIVISION  OF  VENEREAL  DISEASES,  UNITED  STATES  PUBLIC  HEALTH 
SERVICE,  STATE  BOARDS  OR  DEPARTMENTS  OF  HEALTH,  AND  THE  INTERDEPART- 
MENTAL SOCIAL  HYGIENE  BOARD. 

Sec.  6.  *  *  *  the  sum  of  $1,000,000  whicli  shall  be  paid  to  the  States  for 
the  use  of  their  respective  boards  or  departments  of  health  in  the  prevention, 
control,  and  treatment  of  venereal  diseases,  this  sum  to  be  allotted  to  each  State 
in  accordance  with  the  rules  and  regulations  prescribed  by  the  Secretary  of  the 
Treasury  in  the  proportion  which  its  population  bears  to  the  population  of  the 
continental  United  States,  exclusive  of  Alaska  and  the  Canal  Zone,  according 
to  the  last  preceding  United  States  Census,  and  such  allotment  to  be  so  con- 
ditioned that  for  each  dollar  paid  to  any  State  the  State  shall  specifically  ap- 
propriate or  otherwise  set  aside  an  equal  amount  for  the  prevention,  control, 
and  treatment  of  venereal  diseases,  except  for  the  fiscal  year  ending  June  30, 
1919,  for  which  the  allotment  is  not  conditioned  upon  the  appropriation  or  set- 
ting aside  of  money  by  the  State:  Provided,  That  any  State  may  obtain  any 
part  of  its  allotment  for  any  fiscal  year  subsequent  to  June  30,  1919,  by  spe- 
cifically appropriating  or  otherwise  setting  aside  an  amount  equal  to  such  part 
of  its  allotment  for  the  prevention,  treatment,  and  control  of  venereal  diseases. 
(Extract  from  Chapter  XV,  Army  appropriation  bill  of  July  9,  1918.) 

The  regulations  governing  the  use  of  the  allotments  provided  the 
States  by  this  appropriation  from  the  Grovernment  are  promulgated 
by  the  Secretary  of  the  Treasury  in  conformity  with  the  provisions 
of  this  act.  The  disbursements,  auditing,  and  accounting  for  these 
funds  are  activities  that  are  carried  on  by  the  United  States  Inter- 
departmental Social  Hygiene  Board. 

The  Division  of  Venereal  Diseases  of  the  Public  Health  Service  has 
been  authorized  and  directed  by  the  Secretary  of  the  Treasury,  pur- 
suant to  the  authority  vested  in  him  by  this  act,  to  carry  out  the  pro- 
gram which  he  has  prescribed.  The  duties  of  the  Division  of  Ve- 
nereal Diseases,  as  specified  by  Congress — 

shall  be  in  accordance  with  rules  and  regulations  prescribed  by  the  Secretary 
of  the  Treasury  (1)  to  study  and  investigate  the  cause,  treatment,  and  pre- 
vention of  venereal  diseases;  (2)  to  cooperate  with  the  State  boards  or  de- 
partments of  health  for  the  prevention  and  control  of  such  diseases  within  the 
States;  (3)  to  control  and  prevent  the  spread  of  these  diseases  in  interstate 
traffic:  Provided,  That  nothing  in  this  chapter  shall  be  construed  as  limiting 
the  functions  and  activities  of  other  departments  or  bureaus  in  the  prevention, 
control,  and  treatment  of  venereal  diseases  and  in  the  expenditure  of  moneys 
therefor. 

It  is  obvious,  therefore,  that  for  the  year  ending  June  30, 1920,  this 
governmental  fund  for  allotment  to  States  for  the  prevention, 
treatment,  and  control  of  venereal  diseases  involved  in  its  application 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.    101 

in  the  States  the  adoption  and  operation  of  rules  and  regulations 
laid  down  by  the  Secretary  of  the  Treasury  and  a  regular  system  of 
disbursements  and  accounting  in  conformity  with  rules  issued  by  the 
Interdepartmental  Social  Hygiene  Board. 

A  statement  of  these  rules  governing  disbursements  and  account- 
ing are  appended  in  this  report.  It  is  sufficient  here  to  call  attention 
to  the  fact  that  every  effort  has  been  made  in  constructing  these  regu- 
lations to  safeguard  the  Government  and  the  States  so  that  these 
financial  transactions  may  not  at  any  time  be  subject  to  discrediting 
criticism. 

Statement  Summarizing  the  Progress  Made  This  Year  by  the 
Division  of  Venereal  Diseases  or  the  United  States  Public 
Healtpi  Service  in  Cooperation  With  the  States  and  With  the 
United  States  Interdepartmental  Social  Hygiene  Board,  Ap- 
plying THE  Program  Promulgated  by  the  Secretary  or  the 
Treasury  and  Supported  by  the  Federal  Allotments  to  States, 
Through  the  United  States  Interdepartmental  Social  Hy- 
giene Board  for  the  Prevention,  Treatment,  and  Control  of 
Venereal  Diseases  Through  State  Departments  of  Health.^ 

medical  measures. 

(A)    REPORTING. 

Since  the  creation  of  the  Division  of  Veneral  Diseases  a  determined 
effort  has  been  made  to  secure  the  reporting  of  cases  of  venereal  dis- 
ease to  the  State  health  officers  and  thence  to  the  Public  Health  Serv- 
ice. It  was  felt  that  the  first  step  toward  the  cure  of  these  diseases 
was  knowledge  of  the  extent  and  distribution  of  infections.  There- 
fore, one  of  the  conditions  under  which  each  State  received  its  por- 
tion of  the  Chamberlain-Kahn  funds  was  the  existence  of  a  report- 
ing law.  For  two  years  now,  monthly  reports  from  all  States  par- 
ticipating in  the  fund  have  been  received  and  these  figures  are  avail- 
able. 

It  is  not  claimed  that  the  figures  show  the  extent  of  venereal  dis- 
ease in  the  United  States,  because  all  persons  infected  with  such  a 
disease  do  not  go  to  a  physician  for  treatment,  and  because  all  physi- 
cians have  not  yet  been  brought  to  a  realization  of  the  importance  of 
reporting.  It  is  believed,  however,  that  as  people  are  gradually  edu- 
cated to  realize  that  they  must  receive  treatment  from  a  physician, 
and  as  physicians  are  brought  to  realize  more  definitely  their  respon- 
sibility in  the  matter  of  reporting,  the  data  collected  will  have  real 
statistical  value.  What  figures  do  show  definitely,  however,  is  that 
progress  has  been  made  in  this  direction  during  the  past  two  years, 


1  Quoted  from  address  of  Asst.  Surg.  Gen.  C.  C.  Pierce,  Division  of  Venereal  Disease, 
United  States  Public  Health  Service,  before  the  Academy  of  Medicine,  New  York  City,  Oct. 
7,  1920. 


102     REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

and  that  these  figures  may  be  expected  in  time  to  give  a  true  picture 
of  conditions. 

In  1919  there  were  reported  to  the  State  boards  of  health  131,193 
cases  of  gonorrhea ;  100,466  cases  of  syphilis ;  7,843  cases  of  chancroid 
and  others ;  or  a  total  of  239,502  cases  of  venereal  disease.  In  1920 
there  were  reported  to  the  State  boards  of  health,  172,387  cases  of 
gonorrhea;  142,869  cases  of  syphilis;  10,861  cases  of  chancroid  and 
others ;  or  a  total  of  326,117  cases  of  venereal  disease.  The  total  in- 
crease during  the  past  year  therefore  has  been  88,615  cases  or  36  per 
cent.  The  relative  increase  of  the  cases  of  gonorrhea  reported  was 
31  per  cent  and  of  syphilis  42  per  cent. 

As  gonorrhea  is  generally  estimated  as  from  two  to  four  times  as 
prevalent  as  syphilis  a  rough  check  can  thus  be  kept  on  the  finality 
of  reporting  figures.  Not  until  the  number  of  cases  of  gonorrhea 
reported  at  least  doubles  those  of  syphilis,  can  the  reports  be  relied 
on  as  showing  even  approximately  the  true  incidence  of  venereal  dis- 
ease in  the  United  States. 

(B)    TREATMENT. 

After  securing  the  reporting  of  cases  of  venereal  disease  the  next 
step  in  limiting  venereal  infection  is  necessarily  making  available 
proper  treatment  to  all  those  who  are  infected. 

This  is  a  simple  enough  matter  for  the  men  and  women  in  com- 
fortable circumstance,  who,  as  a  matter  of  course,  consult  reliable 
physicians  and  secure  adequate  treatment.  There  are,  however,  a 
great  number  of  people  receiving  moderate  wages  for  whom  a  pro- 
longed course  of  expensive  treatment  is  prohibitive  in  price.  These 
people  are  only  too  prone  when  they  feel  improved  after  a  couple  of 
treatments  to  decide  that  in  view  of  the  expense  incurred  and  the 
benefit  already  received  further  treatments  are  unnecessary.  They 
therefore  form  a  body  of  insufficiently  treated  patients  who  sooner  or 
later  develop  a  recurrence  of  disease.  Then  there  are  also,  of  course, 
the  ignorant  and  indigent  people  who  are  unable  to  pay  anything 
whatever  for  treatment,  and  who  therefore  either  treat  themselves 
with  some  patent  medicine  or  go  without  treatment  and  who  in  either 
case  are  potent  sources  of  infection. 

The  establishment  of  clinics  where  reliable  treatment  can  be  ob- 
tained at  small  cost  or  free  of  charge  for  those  unable  to  pay  was 
believed  to  be  the  way  in  which  to  cope  with  this  difficulty.  The  es- 
tablishment of  such  clinics  throughout  the  United  States  has  there- 
fore been  promoted.  In  1919  there  were  237  clinics  operating  under 
the  joint  auspices  of  State  boards  of  health  and  the  United  States 
Public  Health  Service,  and  167  regularly  reported  their  activities. 
Of  the  total  number  of  clinics,  145  were  established  during  the  year 


REPORT  V.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.    103 

1919.  In  1920  there  were  427  clinics  operating  under  State  boards  of 
health  and  the  United  States  Public  Health  Service,  and  383  clinics 
regularly  reported  their  activities;  190  of  these  clinics  were  estab- 
lished in  1920.  It  can  be  stated  therefore  that  there  was  practically 
a  100  per  cent  increase  in  clinic  facilities  throughout  the  United 
States  during  the  past  year.  There  was  also  a  100  per  cent  increase 
in  clinics  reporting. 

Clinic  reports  show  that  twice  as  many  patients  received  treatment 
in  1920  as  in  1919.  In  1920,  126,131  patients  were  admitted  against 
69,092  admitted  in  1919,  an  increase  as  stated  of  over  100  per  cent. 

Further  than  this  the  figures  show  that  the  treatment  received  by 
patients  becomes  progressively  more  efficient,  for  while  6,922  patients 
were  discharged  as  noninfectious  in  1919,  34,215  were  discharged  as 
noninfectious  in  1920.  Or,  in  other  words,  only  one  patient  out  of 
every  ten  was  discharged  as  noninfectious  in  1919,  while  one  patient 
out  of  ever  three  or  four  was  discharged  as  noninfectious  in  1920. 
Moreover,  as  would  be  expected  from  the  above,  while  the  number 
of  patients  was  doubled,  the  numberof  treatments  was  tripled.     In 

1919,  8  treatments  were  given  for  each  person  admitted,  while  in 

1920,  12.5  treatments  were  given  for  each  patient,  showing  again 
greater  efficiency  in  treatment. 

Nearly  three  times  as  many  Wassermann  tests  were  made  in  1920 
as  in  1919  (63,929,  as  against  175,872  in  1920),  and  nearly  twice  as 
many  microscopic  examinations  for  the  gonococcus  (89,419  as  against 
155,275  in  1920),  showing  the  laboratory  facilities  were  being  utilized 
more  and  more  by  physicians  as  well  as  in  the  clinics  themselves. 

State  boards  of  health  report  328,382  doses  of  arsphenamine  dis- 
tributed to  physicians,  hospitals,  and  clinics  during  1920.  Com- 
pared with  last  year's  report,  118,055,  this  is  an  increase  of  210,327  or 
186  per  cent. 

Other  medical  activities  have  been  included  in  this  campaign  in 
order  to  secure  the  cooperation  of  physicians  and  dentists  and  a 
special  course  for  graduate  nurses  given  at  Columbia  University  in 
order  to  fit  them  for  venereal- disease-control  work. 

(C)     CLINICS. 

The  corner  stone  of  the  medical  side  of  the  work  has,  however,  been 
the  clinics.  A  survey  of  cities  with  a  population  of  15,000  or  over 
made  possible  a  comprehensive  study  by  representatives  of  the  United 
States  Public  Health  Service  of  359  clinics.  The  study  covered  the 
methods  of  operation,  and  it  is  hoped  that  the  result  will  be  improved 
clinic  efficiency. 

Clinics  were  rated  under  the  following  heads,  a  mere  list  of  which 
will  give  some  idea  of  the  scope  of  the  survey:  Location,  equipment, 


104    REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

sterilization,  histories,  records  of  treatment,  use  of  distilled  water, 
personnel,  salaries,  treatment,  clinic  days  and  hours,  daily  average 
attendance,  laboratory  facilities,  fees  charged,  method  of  building 
up  clinic,  average  monthly  cost  of  operation,  per  capita  cost  of 
treatment. 

An  ideal  public-health  venereal-disease  clinic  must  have  a  con- 
venient location,  preferably  in  some  public  building  where  attend- 
ance will  not  be  conspicuous.  There  must  be  facilities  for  diagnosis 
and  for  competent  treatment  for  both  gonorrhea  and  syphilis.  The 
staff  must  be  adequate  for  the  clinic  needs  and  for  the  necessary 
follow-up  work.  There  must  be  day  and  evening  hours,  so  that  those 
employed  can  receive  treatment,  and  there  must  be  sufficient  attend- 
ance to  result  in  a  reasonable  per  capita  cost  of  treatment.  Treatment 
must  be  free  to  those  unable  to  pay. 

I'he  type  of  treatment  given  is,  of  course,  all  important  in  deter- 
mining clinic  efficiency.  The  survey  showed  that  in  325  clinics,  or 
90  per  cent,  the  treatment  for  gonorrhea  was  efficient  and  that  in  337 
clinics,  or  93  per  cent,  the  treatment  for  syphilis  was  efficient.  Three 
hundred  clinics,  or  85,5  per  cent,  had  equipment  which  was  considered 
entirely  adequate. 

Accurate  diagnosis  being  essentially  of  prime  importance,  careful 
observations  were  made  with  regard  to  facilities  for  diagnosis.  It 
was  found  that  dark  field  examinations  could  be  carried  out  in  226 
clinics  (62.9  per  cent)  ;  Wasserman  tests  could  be  made  in  166  clinics 
(46.2  per  cent)  ;  microscopic  examinations  for  the  gonococcus  could 
be  made  in  202  clinics  (56.2  per  cent). 

Out  of  342  clinics  reporting  on  hours,  198  or  57  per  cent,  had  even- 
ing hours.  Out  of  the  309  clinics  reporting  on  attendance  175,  or 
56  per  cent,  had  an  average  daily  attendance  of  between  10  and  100 
patients  per  day,  and  10  of  these  clinics  averaged  over  100  patients 
per  day. 

The  per  capita  cost  of  treatment  is  an  excellent  way  in  which  to 
judge  the  efficiency  of  a  clinic  from  the  standpoint  of  public  health. 
In  50  clinics  this  averaged  50  cents  or  under,  in  79  clinics  it  was  50 
cents  to  $1,  in  37  clinics  it  was  $1  to  $1,50,  and  in  20  clinics  it  was 
$1.60  to  $2.  The  per  capita  cost  of  treatment  was  therefore  under 
$2  in  80  per  cent  of  the  clinics. 

Now  that  one  clinic  survey  has  been  completed  and  analyses  have 
been  made  of  the  data  on  hand,  an  effort  is  being  made  through  the 
representatives  of  the  United  States  Public  Health  Service  to  stimu- 
late the  minority  of  clinics  where  satisfactory  treatment  is  not  given 
in  order  that  they  may  bring  up  their  standard  of  efficiency  to  com- 
pare favorably  with  the  other  clinics.  In  the  course  of  a  few  months 
when  there  has  been  time  for  reorganization,  a  second  survey  will  be 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.    105 

made  and  the  clinics  will  again  be  rated,  credit  for  their  improved 
technique,  etc.,  being  given. 

In  this  way  it  is  hoped  that  the  clinics  may  be  brought  to  conform 
to  a  high  standard  of  efficiency,  so  that  any  man  or  woman  in  the 
United  States  who  is  infected  with  venereal  disease  may  go  to  a  free 
clinic  and  be  absolutely  sure  in  every  case  of  obtaining  the  treatment 
for  the  disease  that  is  considered  most  effective  by  the  best  medical 
authorities  of  the  country. 

(D)   LAW  ENFORCEMENT. 

Although  it  will  be  impossible  to  go  as  fully  into  the  legal  and 
educational  sides  of  the  program  as  has  been  done  on  the  medical 
side,  still  some  consideration  of  these  important  phases  should  be 
attempted  if  only  to  give  a  well-rounded  conception  of  the  scope  of 
the  entire  work  that  is  under  way. 

The  first  care  of  the  legal  section  was,  of  course,  to  see  that  as  many" 
States  as  possible  secured  their  portion  of  the  Chamberlain-Kahn 
fund.     During  the  second  year  it  was  necessary  for  the  State  to 
appropriate  an  equal  amount  in  order  to  do  so.     In  both '1919  and 
1920  47  States  qualified. 

Further  work  of  the  legal  division  consists  in  fostering  the  passage 
of  State  laws  and  city  ordinances  having  for  their  aim  the  control 
of  venereal  disease  and  in  urging  the  enforcement  of  laws  which 
have  been  so  passed.  No  less  than  40  States  in  1919  passed  legisla- 
tion aimed  at  venereal  disease  control;  in  1920,  13  States  did  like- 
wise. In  1919  there  were  222  city  ordinances  of  this  character 
passed  and  in  1920  there  were  102.  Gradually,  of  course,  when  the 
necessary  legislative  background  has  been  secured,  the  work  of  this 
section  will  become  more  and  more  that  of  urging  the  strict  enforce- 
ment of  such  legislation. 

The  character  of  the  legislation  adopted  by  the  States  is  varied. 
Model  laws  and  ordinances  that  have  been  found  serviceable  have 
been  drawn  up  and  have  been  available  to  State  and  cities,  many  of 
these  have  taken  advantage  of  the  forms  and  have  modeled  legisla- 
tion by  them.  Such  laws  and  ordinances  include  those  prohibiting 
the  use  of  taxicabs,  dance  halls,  lodging  houses,  hotels,  etc.,  for  the 
purpose  of  prostitution.  Others  necessitate  compulsory  medical  ex- 
amination and  treatment  for  those  arrested  for  sex  offenses,  and 
still  others  prohibit  the  sale  and  advertising  of  quack  venereal  dis- 
ease remedies  and  nostrums.  The  legal  section  has  as  its  aim  largely 
to  aid  the  various  States  in  the  suppression  of  commercialized  prosti- 
tution as  this  is  undoubtedh?^  the  most  important  focus  for  spreading  . 
venereal  disease. 


106    KEPORT  U.  S.  Il^TERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD. 

(E)    EDUCATIONAL. 

The  aim  of  the  educational  section  is  to  disseminate  sex  instruc- 
tion among  the  public  and  to  bring  before  the  people  the  knowledge 
of  the  dangers  of  venereal  disease  and  the  importance  of  prompt  and 
efficient  treatment. 

Educational  activities  have  included  publication  of  a  number  of 
pamphlets  on  various  phases  of  sex  education  and  hygiene,  and  ad- 
vice to  those  infected  with  venereal  disease.  In  1919  more  than 
14,000,000  pamphlets  were  distributed  in  response  to  requests ;  in 
1920  more  than  8,000,000.  The  explanation  of  the  decrease  in  num- 
ber is  that  such  activities  are  being  shared  more  and  more  with  the 
State  boards  of  health  as  they  are  willing  to  take  over  the  printing 
and  distribution  of  literature.  Framed  placards  giving  advice  to 
persons  infected  with  venereal  diseases  have  been  placed  in  railway 
cars  and  stations  and  other  public  places,  and  have  been  influential 
in  inducing  many  persons  to  consult  a  reliable  physician  or  to  go 
to  a  clinic. 

Physicians  and  educators  of  the  Public  Health  Service  have  given 
many  educational  lectures  before  societies  and  clubs  which  request 
their  services.  In  1919  there  were  more  than  8,000  such  lectures 
given;  in  1920  there  were  12,000,  the  average  attendance  being  be- 
tween 130  and  200  persons. 

Health  exhibits  and  lantern-slide  showings  are  other  features  of 
this  phase  of  work.  More  than  2,000  of  these  showings  were  given 
in  1919,  and  more  than  11,000  in  1920,  the  average  attendance  being 
between  200  and  250.  Over  1,000  educational  motion-picture  show- 
ings were  given  in  1919  and  over  2,000  in  1920. 

(D    CONCLUSION. 

It  is  believed  that  through  educational  work  of  the  type  described 
the  ignorance  of  the  public  on  the  subject  of  venereal  disease  is 
gradually  being  dispelled.  People  are  waking  up  to  the  dangers  and 
consequences  of  venereal  disease  and  to  the  vital  importance  of 
receiving  treatment  when  infected.  At  the  same  time  various  States 
and  cities  are  ridding  themselves  of  commercialized  prostitution, 
through  realization  of  the  danger  caused  by  it  to  the  health  of  the 
community.  Along  with  this  lessened  infection  and  greater  knowl- 
edge comes  the  all-important  work  of  the  venereal-disease  clinics, 
which  now  cover  the  county  in  a  network  whose  function  it  is  to  sift 
out  those  infected  with  venereal  diseases  who  can  not  afford  treat- 
ment and  treat  them  so  that  they  may  no  longer  be  a  source  of  danger 
to  the  community. 

In  these  three  ways  progress  has  been  made  in  limiting  venereal 
infections  in  the  past  two  years,  but  such  progress  since  it  is  built 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.    107 

on  the  solid  foundation  of  an  educated  public  must  of  necessity  be 
gradual.  Elimination  of  venereal  disease  by  any  lightning-stroke 
policy  is  clearly  impossible.  One  can  only  work  steadily  and  sanely 
toward  the  goal  in  view. 

REPORT  ON  THE  DIVISION  OF  SCIENTIFIC  RESEARCH. 

Scientific  researches  supported  by  the  board  for  the  discovery  of 
more  effective  medical  measures  in  the  prevention  and  treatment  of 
venereal  diseases  have  been  extended  and  developed  this  year.  The 
progress  made  in  1918-19  is  described  in  Part  III  of  this  report,  on 
pages  182-184.  At  the  present  time  there  are  35  researches  being 
conducted,  of  which  2  are  investigations  regarding  chancroids,  14 
are  studies  regarding  gonococcus  infection,  and  20  are  researches  in 
relation  to  syphilis.  These  are  described  in  detail  under  the  three 
headings  mentioned. 

Six  preliminary  reports  of  scientific  investigations  aided  by  the 
board  have  been  published  and  are  also  described  in  the  following 
pages. 

Classification   and   Description   of  the    Scientific  Eesearches 

THAT    ARE    BeING   ASSISTED    BY   THE    UnITED    StATES    INTERDEPART- 
MENTAL Social  Hygiene  Board. 

chancroids. 

1.  "Manufacture  and  investigation  of  a  series  of  penetrating  or- 
ganic dyes  in  the  treatment  of  chancroids,"  under  the  direction  of  Dr. 
Hugh  H.  Young  and  Dr.  E.  O.  Swartz,  laboratory  of  the  Brady  Uro- 
logical  Institute,  Johns  Hopkins  Medical  School.  The  purpose  of 
this  research,  as  the  title  indicates,  is  to  secure  a  drug  that  possesses 
the  necessary  penetrating  power  to  reach  the  bacilli  of  Ducrey  which 
are  deeplj?-  buried  in  the  tissues  surrounding  the  chancroidal  ulcer. 
The  drugs  used  at  present  have  been  ineffective  because  of  their  lack 
of  penetrability.  By  the  use  of  organic  dyes,  developed  by  Dr. 
White  at  the  Brady  Institute,  to  which  antiseptic  groups  have 
been  chemically  bound,  Dr.  Young  and  Dr.  Swartz  have  been 
able  to  secure  nonirritating  drugs  of  low  toxicity  and  deep  pene- 
tration, and  of  much  greater  sterilizing  value  than  others  pre- 
viously in  use.  Mercurochrome  220,  one  of  the  new  drugs  that  has 
been  manufactured  in  the  laboratory  of  the  Brady  Urological  Insti- 
tute, has  been  used  in  the  treatment  of  chancroids,  in  the  form  of 
ointments  and  solutions.  Clinical  reports  show  that  this  drug,  used 
as  an  ointment,  is  very  successful,  and  a  great  improvement  on  other 
applications  used.  These  investigations  are  being  continued.  Appro- 
priation for  this  research  was  made  in  May,  1919,  and  renewed  in 
March,  1920. 


108     REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

2.  "  Study  of  the  etiology  of  chancroids  with  especial  reference  to 
bacteriology,  diagnosis  and  serum  reactions,"  by  Dr.  Oscar  Teague, 
in  the  department  of  bacteriology  of  the  College  of  Physicians  and 
Surgeons,  Columbia  University.  Although  much  work  has  been 
done  on  the  Ducrey  bacillus,  there  is  still  a  considerable  amount  of 
uncertainty  as  to  the  etiology  of  chancroid  lesions,  and  practically 
nothing  is  known  concerning  the  more  intimate  bacteriology  of  these 
organisms,  and  the  immunological  and  detailed  transmission  of 
these  organisms.  Investigations  that  have  been  carried  on  in  the 
Columbia  School  of  Medicine,  department  of  bacteriology,  show 
that  it  is  possible  to  find  the  Ducrey  bacilli  in  almost  all  the  chan- 
croid lesions  examined.  Cultural  methods  have  been  found  in  this 
laboratory  which  are  believed  to  make  it  possible  to  secure  bacterio- 
logical diagnosis  of  chancroids  and  of  the  chancroidal  character  of 
mixed  lesions  within  about  24-  hours.  It  is  proposed  to  continue 
this  investigation  on  a  large  scale.  Appropriation  for  this  research 
was  made  in  March,  1920. 

GONORRHEA. 

1.  "An  investigation  into  more  effective  treatment  in  acute  and 
chronic  gonorrhea,"  under  the  direction  of  Dr.  E.  L.  Eigdon,  chief 
genito-urinary  clinic,  and  Dr.  A.  S.  Spaldin^g,  professor  of  gyne- 
cology, Leland  Stanford  Junior  University  Medical  School.  These 
investigators  are  devising  ways  and  means  of  keeping  very  close 
supervision  over  a  large  number  of  patients  suffering  from  acute  and 
chronic  gonorrhea  who  visit  their  clinics,  and  are  investigating  sys- 
tematically the  newer  methods  of  treatment  that  have  been  pro- 
posed for  these  diseases.  The  efficiency  of  this  treatment  is  to  be 
checked  up  by  carefully  controlled  bacteriological  examinations.  An 
effort  will  be  made  to  improve,  if  possible,  the  methods  that  are 
found  to  be  most  efficacious.  It  is  highly  important  that  improved 
methods  for  treating  gonorrhea  be  found,  because  many  individuals 
having  the  disease  fail  to  continue  their  treatment  sufficiently  long- 
to  be  entirely  cured.  The  appropriation  for  this  research  was  made 
in  April,  1919. 

2.  "  Experimental  study  of  various  methods  of  venereal  prophy- 
laxis with  the  object  of  developing  simpler  technic,  and  more  ef- 
ficient and  less  expensive  drugs,"  under  the  direction  of  Dr.  Hugh 
H.  Young,  assisted  by  Dr.  William  Jacks,  of  the  Brady  Urological 
Institute,  Johns  Hopkins  Medical  School.  The  venereal  prophylaxis 
in  present  use  in  the  Armj^  depends  upon  drugs  and  apparatus  avail- 
able only  in  especially  equipped  stations,  and  is  tedious  in  adminis- 
tration. The  purpose  of  this  research  is  to  procure  a  preventive  for 
the  Army  more  easily  applicable  and  less  expensive.    Experimental 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD.    109 

animals  infected  with  syphilis  and  gonorrhea  have  jjeen  used  as  the 
basis  for  this  research.  Tests  have  been  made  on  the  gonococciis  with 
mercurials  developed  in  this  laboratory,  with  soaps,  with  mixtures  of 
acid  reaction  fatal  to  gonococci,  and  with  various  mixtures  usually 
prepared  as  a  paste  with  starch,  or  gum  acacia  and  glycerine.  Studies 
on  the  effect  of  these  substances  are  jusc  beginning  on  the  spirochaeta. 
It  is  hoped  that  it  will  be  possible  to  secure  a  drug  for  the  early 
treatment  of  the  venereal  diseases  that  will  be  effective  in  a  single 
application,  and  colorless,  odorless,  nonirritating,  water-soluble, 
and  fatal  to  both  gonococcus  and  spirochaeta  in  a  very  short  time. 
The  results  already  obtained  are  considered  promising  in  a  high  de- 
gree. Appropriation  for  this  research  was  made  in  May,  1919,  and 
renewed  in  March,  1920. 

3.  "Development  of  new  synthetic  drugs  for  the  treatment  of 
gonorrhea,"  under  the  direction  of  Dr.  Hugh  H.  Young,  professor 
of  urology,  and  Dr.  E.  C.  White,  experimental  chemist  to  the  Brady 
Urological  Institute,  Johns  Hopkins  Medical  School,  assisted  by  Dr. 
E.  O.  Swartz  and  R.  W.  Hale,  jr.  The  drugs  in  present  use  in  the 
treatment  of  acute  gonorrhea  have  been,  in  the  main,  ineffective. 
This  investigation  is  for  the  purpose  of  synthesizing  drugs  which 
will  possess  qualities  superior  to  those  drugs  in  present  use,  and 
testing  their  comparative  antiseptic  values  experimentally  and  clini- 
cally. A  considerable  number  of  new  and  original  organic  chemical 
compounds  consisting  of  mercury  and  dibromfluorescein,  a  substance 
closely  related  to  eosin,  have  been  synthesized  and  tested  clinically 
as  well  as  in  the  laboratory.  The  most  successful  of  these  com- 
pounds to  date  is  mercurochrome  220,  a  new  antiseptic,  which  has 
been  found  to  be  more  potent  and  at  the  same  time  less  toxic  and 
irritating  than  other  chemicals  now  in  use.  Drs.  Young,  White, 
and  Swartz  in  synthesizing  this  new  compound  seem  to  have  been 
successful  in  loading  the  penetrating  power  of  a  dye  with  the  germ- 
killing  power  of  mercury  in  a  nonirritating  form.  Aimed  at  a 
disease  almost  as  prevalent  as  measles  and  as  serious  as  gonorrhea, 
mercurochrome  does  not  lack  a  wide  field.  There  seems  to  be  the 
promise  of  large  possibilities  in  the  early  clinical  findings.  The 
compound  is  now  on  the  market  and  available  for  the  use  of  physi- 
cians. Its  use,  which  is  now  being  rapidly  taken  up  throughout  the 
United  States,  has  resulted  in  the  cure  of  hundreds  of  cases  of  severe 
infection  which  had  hitherto  resisted  all  efforts  to  cure.  A  full 
report  of  this  research  is  to  be  found  in  the  Journal  of  the  American 
Medical  Association,  November  15,  1919,  volume  73.  The  investiga- 
tion is  being  continued,  and  recent  reports  indicate  that  additional 
advance  has  been  made  in  the  perfection  of  this  drug.  Scientific 
processes  whose  discovery  has  been  aided  by  the  United  States 
Interdepartmental  Social  Hygiene  Board  are  not  patentable.    The 


110    REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

appropriation  for  this  research  was  made  in  May,  1919,  and  renewed 
in  March,  1920. 

4.  "  Investigations  relative  to  the  development  of  an  internal  uri- 
nary antiseptic,"  under  the  direction  of  Dr.  Edwin  G.  Davis,  director 
of  the  pathological  laboratory,  University  of  Nebraska  College  of 
Medicine.  In  previous  studies  carried  out  by  Dr.  Davis,  it  has  been 
possible  to  establish  a  definite  relationship  between  the  chemical  struc- 
ture and  renal  excretion  of  drugs,  and  to  predict  with  reasonable  ac- 
curacy which  drugs  would  be  likely  to  be  excreted.  It  has  further 
been  possible  to  so  modify  these  compounds  chemically  as  to  pro- 
duce an  antiseptic  compound  excreted  by  the  kidney.  A  number 
of  compounds  shown  worthy  of  further  investigation  have 
been  selected  and  are  at  present  being  tested,  using  urine  as 
a  culture  medium.  It  has  been  shown  that  many  compounds  which 
are  antiseptic  in  ordinary  culture  media  lose  this  property  in 
urine,  and  that  tremendous  variation  in  antiseptic  strength  is  caused 
by  variations  in  the  hydrogen  ion  concentration  of  the  urine.  Of 
these  compounds,  one  has  been  discovered  which  given  intravenously 
to  rabbits  renders  the  urine  an  unsuitable  culture  medium  for  the 
staphylococcus.  These  investigations  will  be  followed  up  clinically 
if  results  justify.  The  tremendous  importance  of  research  along  the 
lines  suggested  here  should  be  Yerj  apparent.  The  present  method 
of  treating  infection  of  the  urinary  tract  is  limited  largely  to  irri- 
gation of  the  urethra  and  the  bladder  and  it  can  not  well  be  given 
until  the  acute  stage  of  the  disease  has  passed.  The  discovery  of  an 
internal  urinary  antiseptic  will  not  only  increase  the  effectiveness  of 
genito  urinary  medication,  but  it  will  also  make  it  possible  to  begin 
treatment  more  promptly.  The  appropriation  for  this  research  was 
made  in  June,  1919. 

5.  "  Investigation  of  the  value  of  certain  anilin  dyes  in  the  treat- 
ment of  gonorrhea,"  under  the  direction  of  Dr.  E.  G.  Davis,  director 
of  the  pathological  laboratorj^^.  University  of  Nebraska  College  of 
Medicine.  This  investigation  includes  a  preliminary  investigation  of 
the  antiseptic  properties  of  a  large  number  of  anilin  dyes  on  ordinary 
media  against  the  colon  bacillus  and  staphylococcus,  the  determina- 
tion of  the  antiseptic  strength  on  special  media  against  the  gonococcus 
of  a  limited  number  of  dyes  selected  by  preliminary  tests,  determina- 
tion by  animal  experimentation  of  the  toxicity  and  diffusibility  of 
these  dyes  which  may  be  found  to  inhibit  the  gonococcus  in  vitro  in 
high  dilution,  and  the  clinical  trial  of  any  dyes  which  may  be  found 
to  be  gonococcidal,  nontoxic,  nonirritating  and  diffusible.  Out  of 
185  dyes  tested  out,  20  which  gave  promise  of  value  have  been  se- 
lected for  further  investigation.  Suitable  media  for  growing  the 
gonococcus  are  being  prepared.  A  laboratory  and  clinical  investi-- 
gation  of  acriflavine  in  the  treatment  of  gonorrhea  has  also  been 


KEPOBT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.    HI 

carried  on  in  connection  with  this  research.  A  report  of  this  investi- 
gation is  contained  in  an  article  prepared  bj^  Dr.  Davis  entitled 
"  Further  observations  on  acriflavine  in  gonorrhea "  printed  in 
the  Nebraska  State  Medical  Journal  for  January,  1920,  Volume  V, 
No.  1,  page  19.  Acriflavine  possesses  a  powerful  antiseptic  action, 
and  this  action  is  retained  in  the  presence  of  urine.  It  is  nontoxic, 
nonirritating,  and  diffusible.  No  extravagant  claims  are  made  for 
the  efficiency  of  acriflavine  in  the  treatment  of  gonorrhea,  although 
the  statement  seems  fully  justified  that  distinctly  better  results  are 
secured  with  acriflavine  than  with  the  organic  silver  preparations  in 
common  use.  Appropriation  for  this  research  was  made  in  June, 
1919. 

6.  "A  study  of  the  permeability  of  bacterial  membranes,  particu- 
larly the  organisms  of  venereal  disease,"  under  the  direction  of  Dr. 
W.  P.  Larson,  chief  of  the  department  of  bacteriology  and  immunol- 
ogy, and  Dr.  J.  M.  McClendon,  associate  professor  of  physiology,  Uni- 
versity of  Minnesota  Medical  School.  Investigations  already  under- 
taken in  the  laboratories  of  the  Minnesota  Medical  School  go  to  show 
that  the  destruction  or  disruption  of  bacteria  under  the  influence  of 
various  chemicals,  immune  serums,  etc.,  depends  upon  the  electro- 
conductivity  and  surface  tension  of  these  bacteria.  The  action  of 
such  agents  upon  these  organisms  is  believed  to  be  due  to  changes  pro- 
duced in  the  bacterial  membranes.  The  problem  proposed  contem- 
plates a  study  of  these  conditions  as  affecting  the  permeability  of 
bacterial  membranes  with  a  view  to  throwing  light  upon  the  phe- 
nomenon of  immunity  resulting  from  certain  types  of  infection.  It 
is  the  intention  of  the  investigators  to  trace  the  processes  in  im- 
munochemistry  by  the  electroconductivity  method  first  in  organisms 
that  are  easily  cultivated  and  later  in  the  organisms  that  are  respon- 
sible for  gonorrhea  and  syphilis.  This  investigation  of  the  funda- 
mental or  immunochemical  phenomena  involved  in  these  two  dis- 
eases should  result  in  increasing  our  knowledge  concerning  the 
mechanism  of  the  reactions  that  take  place  .in  the  body.  Knowledge 
of  this  nature  is  necessary  in  order  to  combat  these  diseases  more 
effectively.  The  appropriation  for  this  research  was  made  in  June, 
1919,  and  renewed  in  April,  1920. 

1.  "  Studies  in  the  bacteriology  of  the  gonococcus — its  growth  pe- 
culiarities, classification,  immunizing  properties,  and  its  mode  of 
infecting  experimental  animals,"  under  the  direction  of  Dr.  E.  A. 
Kinsella,  director  of  the  department  of  experimental  medicine,  St. 
Louis  University  College  of  Medicine,  assisted  by  Dr.  G.  O.  Brown 
and  Miss  Natalie  Arnstein.  The  methods  employed  in  the  research 
have  to  do  with  the  cultivation  of  the  gonococcus  by  suitable  media, 
an'd  the  classification  of  the  strains  of  gonococci  obtained  from  acute 
cases  of  infection.    Progress  has  been  fairly  satisfactory  and  it  has 


112    REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL.  HYGIENE  BOARD. 

been  possible  to  devise  a  medium  which  is  very  satisfactory  for  cul- 
tivating large  amounts  of  gonococci.  Serum  agar  has  been  employed 
successfully  for  isolating  gonococci  from  human  sources.  Certain 
grades  in  oxygen  and  carbon  dioxide  tension  have  not  been  found 
necessary.  Animals  have  been  successfully  immunized  to  gonorrheal 
infection,  by  intravenous  inoculation,  and  agglutination  reactions, 
positive  in  dilutions  of  1-5,000,  have  been  easily  obtained.  The 
success  of  the  work  during  the  past  year  makes  it  seem  reasonable 
to  hope  that  some  means  for  shortening  the  days  of  the  acute  infec- 
tion may  be  discovered.  The  appropriation  for  this  research  was 
made  in  June,  1919,  and  renewed  in  April,  1920. 

8.  "  Investigation  of  phenol-alcohol  derivatives  in  relation  to  their 
antiseptic  and  chemotherapeutic  actions  on  the  gonococcus  and  the 
spirochaeta,"  under  the  direction  of  Dr.  A.  D.  Hirschf elder,  chief 
of  the  department  of  pharmacology,  with  the  collaboration  of  Merrill 
C.  Hart  and  F.  J.  Kucera,  University  of  Minnesota  Medical  School. 
Previous  to  this  research,  the  phenol-alcohol  group  had  been  very 
little  studied,  although  there  is  reason  to  believe  that  the  substances 
combine  a  definite  antiseptic  power  with  a  low  toxicity,  and  that 
higher  derivatives  can  be  synthesized  in  which  these  characteristics 
can  be  greatly  enhanced.  The  starting  point  for  this  research  was  the 
synthesis  of  saligenin.  An  improved  method  for  synthesizing 
saligenin  has  been  perfected,  and  some  work  has  been  done  with  the 
syntheses  of  nitro-saligenin  and  mercury-saligenin  compounds. 
These  compounds  have  been  investigated  chemically  and  have  also 
been  tested  biologically.  The  investigations  include  tests  for  the 
purpose  of  demonstrating  the  antiseptic  and  chemotherapeutic  value 
of  these  compounds.  In  the  sodium  salt  of  mercury-saligenin.  Dr. 
Hirschfelder  has  synthesized  a  compound  that  possesses  about  the 
same  antiseptic  powers  as  the  bichloride  of  mercury.  It  has  been 
found  free  from  irritating  properties  in  the  concentration  required 
for  antiseptic  purposes.  It  has  the  further  advantage  of  not  being 
a  dye.  Preliminary  tests  of  its  value  in  the  treatment  of  gonorrheal 
urethritis  are  promising.  Studies  upon  other  members  of  the  phenyl 
carbinol  series  are  under  way.  A  tremendous  number  of  different 
types  of  these  compounds  can  be  synthesized,  some  of  which  seem 
bound  to  possess  valuable  powers.  It  is  hoped  that  the  synthesis  of 
some  of  the  simpler  members  of  the  series  will  indicate  the  direction 
in  which  the  best  results  can  be  accomplished.  The  appropriation  for 
this  research  was  made  in  June,  1919,  and  renewed  in  April,  1920. 

9.  "  A  serological  study  of  the  gonococcus  group,"  under  the  direc- 
tion of  Dr.  John  C.  Torrey,  director  of  the  department  of  hygiene, 
assisted  by  George  T.  Buckell  and  Luther  Conklin,  Cornell  Uni- 
versity Medical  College,  New  York  City.  The  primary  object  of 
this  study  is  to  determine  whether  the  gonococcus  group  can  be  divided 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD.    113 

into  a  number  of  more  or  less  distinct  types,  as  has  been  done  with  the 
pneumococcus,  and,  to  a  certain  extent,  with  the  meningococcus.  The 
first  part  of  the  investigation  is  a  serological  stud}^  which  has  not 
been  completed.  It  has  been  found  that  there  are  strains  within  the 
gonococcus  group  that  are  distinct  serologically,  although  there  is  a 
greater  degree  of  homogeneity  than  was  expected.  This  is  a  promis- 
ing sign.  Considerable  success  has  been  attained  in  keeping  the  dif- 
ferent strains  alive.  A  valuable  plating  medium  has  been  disf-ov- 
ered  that  favors  the  development  of  the  gonococcus  and  inhibits  the 
growth  of  other  types  of  bacteria.  It  is  hoped  that  the  research  will 
lead  to  the  discovery  of  a  more  satisfactory  antigen  for  use  in  the 
complement  fixation  test  for  gonococcus  infections  which  would  prove 
of  especial  importance  in  diagnosing  obscure  chronic  conditions.  Such 
a  test  will  also  help  determine  Avhether  a  person  is  cured  of  gonorrhea. 
It  is  not  unlikely  that  vaccine  therapy  can  be  made  more  valuable  if  a 
vaccine  more  representative  of  the  whole  group  of  gonococci  can  be 
secured.  This  investigation  will  permit  the  selection  of  the  best  cul- 
tures for  the  preparation  of  a  stock  vaccine,  and  hence  bring  this 
mode  of  treatment  to  the  highest  point  of  efficiency  of  which  it  is 
capable.  The  appropriation  for  this  research  was  made  in  June, 
1919. 

10.  "An  intensive  study  of  methods  for  the  isolation  and  identifica- 
tion of  the  gonococcus  with  a  view  to  the  determination  of  the 
homogeneity  or  heterogeneit}^  of  strains  and  their  etiological  rela- 
tionships," under  the  direction  of  Dr.  George  H.  Smith,  assistant 
professor  of  pathology  and  bacteriology,  Yale  University  Medical 
School,  assisted  by  Dr.  Elliot  S.  Robinson  and  Miss  Marion  E. 
Snavely.  The  first  step  in  carrying  out  the  purpose  of  this  research 
was  to  find  a  means  of  cultivating  the  gonococcus  with  a  minimal 
amount  of  labor  and  equipment.  The  investigation  has  revealed  the 
fact  that  the  power  of  growth  of  the  gonococcus  can  be  increased  and 
the  viability  of  the  organism  enhanced  by  cultivation  under  specific 
physical  conditions,  especially  as  regards  the  presence  of  moisture 
and  the  reduction  of  oxygen  tension.  Not  all  culture  media  advo- 
cated for  the  cultivation  of  the  gonococcus  meet  the  requirements 
regarding  luxuriance  and  viability  of  growth.  Some  are  particularly 
well  adapted  to  maintain  the  viability  of  the  organisms.  Others  seem 
particularly  well  adapted  for  a  luxuriant  growth.  When  grown 
under  the  conditions  provided  by  Dr.  Smith  in  the  Brady  Laboratory 
of  Pathology  and  Bacteriology,  organisms  remain  viable  for  at  least 
a  month,  as  compared  with  two  or  three  days  under  normal  atmos- 
pheric pressure.  It  is  of  the  utmost  importance  that  satisfactory 
cultural  methods  for  the  study  of  the  gonococcus  (its  isolation  and 
identification)  be  discovered  if  specific  biologic  therapy  for  the  in- 
15610—20 8 


114    EEPOKT  U.  S.  INTERDEPAETMENTAL  SOCIAL  HYGIENE  BOARD. 

fection  with  the  gonococcus  is  to  be  successful.  Sufficient  progress 
has  been  made  on  this  investigation  to  allow  a  publication  in  the  near 
future.    The  appropriation  for  this  research  was  made  in  June,  1919. 

11.  "An  investigation  for  the  establishment,  if  possible,  of  a  better 
and  more  definite  standard  of  cure  of  gonorrheal  infection  in  the 
male,"  under  the  direction  of  Dr.  L.  Hektoem,  director  of  the  John 
McCormick  Institute  for  Infectious  Diseases,  assisted  by  Dr.  Russell 
D.  Herrold  and  Ursula  S.  Herrold.  The  methods  employed  in  this 
research  are  (1)  bacteriologic,  with  the  special  object  of  determin- 
ing the  presence  or  absence  of  the  gonococcus  in  cases  under  treatment, 
and  (2)  serologic  tests  for  gonorrhea  and  the  results  of  gonococcus  in- 
fection. Improved  methods  have  been  devised  and  are  now  being 
employed  in  the  detailed  study  of  cases  of  chronic  and  latent  gonococ- 
cus infection.  A  simplified  plate  method  for  growing  the  gonococcus 
under  reduced  oxygen  tension  has  been  worked  out  (see  Journal 
American  Medical  Association,  1920,  vol.  74,  p.  1T16),  which  is  of 
much  value  in  making  cultures  of  prostate  and  seminal  fluids  to  de- 
termine whether  a  complete  cure  of  gonorrhea  has  been  established. 
The  plate  method  devised  by  Dr.  Herrold  makes  it  possible  to  make 
smears  of  sufficient  magnitude  to  allow  the  growth  of  discrete  colonies 
of  organisms.  It  has  been  found  that  the  result  of  fixation  tests  may 
serve  as  an  index  of  the  existence  of  foci  of  gonococcus  infections. 
An  improved  method  has  also  been  found  for  testing  the  agglutina- 
tion of  gonococci  which  is  proving  useful  in  studying  the  question 
of  strains  of  gonococci.  The  improvements  in  technic  that  have  been 
developed  in  connection  with  this  research  are  of  scientific  interest, 
for  there  can  be  no  doubt  that  they  will  help  to  establish  a  consid- 
erably more  effective  treatment  of  gonorrhea,  because  they  place  in 
our  hands  the  means  for  a  better  control  of  the  results.  The  appro- 
priation for  this  research  was  made  in  November,  1919. 

12.  "A  selective  medium  for  the  isolation  and  cultivation  of  the 
gonococcus,"  under  the  direction  of  Dr.  Henry  Albert,  professor  of 
pathology  and  bacteriology.  University  of  Iowa  College  of  Medicine, 
assisted  by  Dr.  Mary  Erickson.  The  problem  here  has  been  to  find 
a  culture  medimn  that  will  either  especially  favor  the  growth  of  the 
gonococcus,  or  inhibit  the  growth  of  other  bacteria  present,  or  both, 
so  that  the  gonococcus  may  be  readily  discovered  in  cases  of  mixed 
infection.  This  investigation  has  required  the  testing  of  many  cul- 
ture media,  the  making  of  various  modifications  as  regards  ingre- 
dients, reaction,  etc.,  and  the  doing  of  experimental  work  with  new 
media  in  which  various  ingredients  have  been  incorporated  for  the 
purpose  of  stimulating  the  growth  of  the  gonococcus  or  inhibiting 
the  growth  of  other  organisms.  The  experiments  are  very  hopeful 
of  a  satisfactory  solution  of  the  problem  under  investigation.  A  cul- 
ture medium  has  been  found  upon  which  the  gonococcus  grows  readily 


REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL,  HYGIENE  BOARD.    1 1  5 

and  profusely  and  which  inhibits  the  growth  of  certain  other  organ- 
isms that  may  be  present  in  mixed  infections.  The  successful  conclu- 
sion of  this  research  will  make  it  possible  to  diagnose  more  accurately 
obscure  chronic  gonorrheal  infections,  and  institute  specific  treatment. 
Success  in  isolating  the  gonococcus  from  chronic  infections  will  make 
it  possible  to  prepare  autogenous  vaccines  which  are  always  more  effec- 
tive than  the  ordinary  stock  vaccine.  The  research  possesses  socio- 
logic  importance  because  of  its  promise  to  furnish  a  better  means  for 
knowing  when  a  case  of  gonorrhea  is  free  from  infection.  The  ap- 
propriation for  this  research  was  made  in  February,  1920. 

13.  "  Classification  of  gonococci  and  fixation  reaction  in  gonor- 
rhea," under  the  direction  of  Dr.  Frederick  P.  Gay,  professor  of 
pathology,  University  of  California,  assisted  by  Dr.  Marjorie  W, 
Cook  and  Mr.  Douglas  D.  Stafford.  Gonococci  obtained  from  acute 
and  chronic  infections,  due  to  this  microorganism,  are  being  studied 
with  a  view  to  establishing  whether  or  not  types  of  the  microorganism, 
exist  similar  to  those  described  among  the  pneumococci  and  strepto- 
cocci. It  is  also  planned  to  investigate  the  reactions  of  patients  in 
the  way  of  antibody  formation  of  the  respective  type  or  types  de- 
termined. The  value  of  this  research  lies  in  the  possible  discovery 
of  more  detailed  knowledge  of  the  etiology  of  gonorrheal  infections, 
better  methods  of  serum  diagnosis,  and  possibly  of  vaccine  and  serum 
treatment  of  these  infections.  The  appropriation  for  this  research 
was  made  in  March,  1920. 

14.  "  Improvement  in  methods  for  determining  infection  as  em- 
ployed in  cultures  and  complement  fixation  in  subacute  and  chronic 
gonorrhea  and  results  of  frequent  tests  in  cases  under  treatment  and 
detention,"  under  the  direction  of  Dr.  William  H.  Park,  professor  of 
bacteriology  and  hygiene.  New  York  University  and  Bellevue  Hos- 
pital Medical  College,  assisted  by  Dr.  Noble,  Dr.  Frankel,  and  Miss 
Wilson.  The  diagnosis  of  suspected  cases  of  gonorrheal  infection  in 
women  sent  to  hospitals  by  the  court  presents  a  problem  that  is  not 
always  readily  solved.  After  determining  whether  such  patients  can 
be  detained,  it  becomes  necessary  to  determine  how  long  they  may  be 
detained  for  treatment.  The  use  of  ordinary  smears  has  been  found 
insufficient  for  diagnosis.  Dr.  Park  proposes  to  investigate  the  com- 
plement fixation  test  as  a  means  for  diagnosing  gonorrhea  in  subacute 
and  chronic  cases.  He  has  been  able  to  improve  the  test  in  such  a 
wa}^  that  it  gives  reliable  evidence  for  diagnosis  in  about  85  per  cent 
of  the  cases.  His  investigations  seem  to  indicate  that  the  disappear- 
ance of  the  positive  test  is  sufficient  evidence  to  certify  individuals  as 
free  from  the  danger  of  giving  infection.  This-  research  will  result 
in  bringing  together  clinical,  serological,  and  bacteriological  findings 
in  cases  of  suspected  or  diagnosed  subacute  or  chronic  gonorrhea  and 
shed  additional  light  on  the  problem  of  diagnosing  suspected  cases 


116      REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD. 

and  determining  the  period  of  infection  in  known  cases.  An  effort 
will  also  be  made  to  improve  the  cultural  methods  for  the  gonococcus 
so  that  it  will  be  possible  to  detect  small  numbers  of  gonococci  in  the 
discharge  of  subacute  cases.  The  appropriation  for  this  research  was 
made  in  June,  1920. 

SYPHILIS. 

1.  "A  research  for  an  improved  method  of  demonstrating  the 
spirochaeta  pallida  in  human^tissues,"  under  the  direction  of  Dr.  A. 
S.  Warthin,  director  of  the  Pathological  Laboratory,  College  of  Medi- 
cine and  Surgery,  University  of  Michigan,  assisted  by  Mr.  Allen  C. 
Starry  and  Miss  Ida  Wieber.  There  is  nothing  more  important  in 
the  diagnosis  of  syphilis  than  the  ability  to  demonstrate  quickly  and 
isurely,  in  sections  of  tissue,  the  presence  of  the  organisms  of  syphilis, 
inasmuch  as  the  positive  diagnosis  of  syphilis  depends  upon  the 
demonstration  of  these  organisms.  The  Levaditi  method,  which  is 
the  chief  method  used  in  the  demonstration  of  the  spirochaetes  of 
syphilis  in  tissues,  requires  6  to  14  days,  is  too  complicated  for 
the  average  technician,  and  its  results  are  capricious,  so  that  this 
method  is  not  available  in  ordinary  routine  diagnostic  work.  Dr. 
Warthin's  problem  has  been  to  obtain  an  easier  and  quicker  method. 
His  investigation  has  resulted  in  the  discovery  of  a  greatly  improved 
method  of  demonstrating  the  organisms  of  syphilis  in  tissue,  which 
takes  about  12  hours.  The  details  of  this  method  have  been  published 
in  the  American  Journal  of  Syphilis,  January,  1920.  Dr.  Warthin 
has  recently  succeeded  in  improving  the  technic  of  his  method  so  that 
the  demonstration  of  the  treponema  pallida  can  be  made  in  one  hour. 
A  report  of  this  newer  method  is  to  be  published  shortly.  This  re- 
search has  made  a  valuable  contribution  to  the  knowledge  of  patholo- 
gists regarding  the  examination  of  human  tissues  for  the  organisms 
of  syphilis.  Hitherto  the  tissue  diagnosis  of  syphilis  has  been  ineffi- 
ciently carried  out  in  the  diagnostic  laboratories  because  of  the  diffi- 
culties attending  the  older  methods  employed.  These  new  methods 
will  lead  to  more  frequent,  more  rapid,  and  more  certain  diagnoses  of 
syphilitic  infection,  thereby  making  it  possible  to  give  a  greater  per- 
centage of  proper  and  more  effective  treatment.  The  sociological 
value  of  the  research  lies  in  the  fact  that  diagnosticians  will  be  able 
to  select  more  accurately  the  cases  needing  syphilitic  treatment  and  in 
this  way  reduce  the  number  of  cases  that  are  potential  dangers  to 
other  individuals.  The  appropriation  for  this  research  was  made  in 
March,  1919. 

2.  "An  investigation  into  more  effective  methods  of  treating 
sjqDhilis,'"'  under  the  direction  of  Dr.  H.  E.  Alderson,  associate  pro- 
fessor of  clinical  medicine,  and  chief  of  the  skin  clinic,  Leland  Stan- 
ford Junior  University  Medical  School,  assisted  by  H.  C.  Coe  and 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      117 

Mrs.  R.  T,  Sheparclson.  The  problems  being  investigated  in  con- 
nection with  this  research  are  (1)  tb«  value  of  the  provocative  Was- 
sermann,  (2)  the  value  of  luetin,  (3)  certain  phases  of  the  Wasser- 
mann  reaction,  such  as  the  relative  delicacy  of  the  antigens  used  and 
the  value  of  the  ice-box  incubation  method,  and  (4)  standardization 
of  the  treatment  of  syphilis.  Dr.  Alderson  is  endeavoring  to  stand- 
ardize the  treatment  of  sjq^hilis  and  determine  just  how  intensive 
the  treatment  can  be  given  without  damage  to  the  patient.  It  is 
believed  that  the  eradication  of  the  treponema  pallida  in  the  early 
stages  of  syphilis  can  best  be  accomplished  by  giving  intensive  treat- 
ment. This  research,  in  common  with  the  other  researches  that  are 
being  carried  on  in  cooperation  with  the  United  States  Interdepart- 
mental Social  Hygiene  Board,  possesses  scientific,  economic,  and 
sociologic  values  that  must  be  perfectly  obvious  to  anyone  who  is 
informed  regarding  the  far-reaching  results  of  syphilis  and  gon- 
orrhea. The  appropriation  for  this  research  was  made  in  April,. 
1919. 

3.  "  The  permeability  of  the  meninges  to  antisyphilitic  drugs — an 
attempt  to  increase  their  permeability,"  under  the  direction  of  Dr. 
H.  G.  Mehrtens,  assistant  professor  of  neurology,  Leland  Stanford 
Junior  University  Medical  School,  assisted  by  Dr.  William  McKay, 
A.  Motzkau,  C.  A.  McArthur,  and  P.  S.  Williams.  It  is  hardly  neces- 
sary to  emphasize  the  importance  of  this  research.  The  amount  of 
suffering  and  death  produced  by  cerebrospinal  syphilis  is  enormous, 
and  any  methods  that  will  improve  the  treatment  of  this  affliction 
will  necessarily  be  a  great  boon  to  humanity.  The  problems  being 
investigated  by  Dr.  Mehrtens  may  be  divided  into  two  groups.  The 
first  group  of  investigations  deals  with  intravenous  injections  of 
arsphenamine  in  an  attempt  to  find  out  how  often  a  single  injection 
of  arsphenamine  appears  in  the  spinal  fluid,  the  effect  of  complete- 
drainage  of  the  spinal  fluid  following  an  intravenous  injection  on 
the  amount  of  arsenic  found  in  the  spinal  fluid,  and  the  effect  of  pre 
liminary  irritation  of  the  meninges  on  the  amount  of  arsenic  pene 
trating  after  intravenous  injection.  The  second  group  of  investiga 
tions  deals  with  the  problems  related  to  rectal  administration  of 
arsphenamine.  Dr.  Mehrtens  summarizes  the  results  of  his  investi- 
gations to  date  as  follows:  (1)  As  40  per  cent  of  all  cases  were 
shown  to  have  membranes  permeable  to  arsphenamine,  every  case  of 
neurosyphilis  should  have  the  benefit  of  intensive  intravenous  medi- 
cation; (2)  the  experiments  would  suggest  that  for  the  cases  re- 
sistant to  ordinary  therapy,  in  order  to  obtain  the  maximum  con- 
centration of  arsenic  in  the  spinal  fluid,  the  patient's  own  serum 
should  be  injected  into  the  subarachnoid  space  six  hours  before  the 
arsphenamine  is  given  intravenously;    (3)   to  be  of  any  practical 


118      REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD. 

use  neoarsplienamine  should  be  injected  rectally  in  doses  not  less 
than  4  grams;  (4)  the  rectal  injection  of  4  grams  neoarsphenamine 
(or  perhaps  even  larger  amounts)  may  be  the  treatment  of  choice 
when  the  veins  are  not  available  for  intravenous  treatment.  Both 
groups  of  investigations  are  being  continued.  The  appropriation  for 
this  research  was  made  in  April,  1919,  and  renewed  in  June,  1920. 

4.  "  The  manufacture  and  investigation  of  a  series  of  new  organic 
compounds  in  the  treatment  of  syphilis,"  under  the  direction  of  Dr. 
Hugh  H.  Young,  director  of  the  Brady  Urological  Institute,  in 
collaboration  with  Dr.  D.  M,  Davis,  both  of  the  department  of  urol- 
ogy, Johns  Hopkins  University  and  Hospital.  Salvarsan  is  now  ad- 
mitted to  have  failed  in  producing  radical  cures  of  syphilis,  and 
mercury  is  again  being  used  to  complete  the  cures.  But  great  diffi- 
culties still  exist  in  using  mercury,  owing  to  the  frequency  of  toxic 
results,  especially  on  the  kidneys.  This  research  aims  to  produce 
new  mercurial  drugs  that  will  be  less  irritating  to  the  kidneys  and 
therefore  tolerated  by  the  system  in  larger  quantity.  Some  of  the 
results  that  have  been  secured  point  to  the  possibility  of  making 
much  progress  along  this  line.  The  starting  point  of  this  investiga- 
tion was  the  synthesis  of  a  number  of  new  and  original  organic 
chemical  compounds,  notably  a  set  of  mercury  bearing  phthaleins 
and  azo  dyes.  The  mercurial  drugs  developed  in  this  laboratory  have 
been  shown  by  various  toxicological  tests  to  be  much  less  toxic  than 
ordinary  mercurials.  Tests  show  that  these  compounds  are  split  in 
the  body  and  that  the  mercury  is  slowly  excreted.  Injury  to  the 
kidney  is  therefore  kept  at  a  minimum.  Dyes  bearing  arsenic  in  ad- 
dition to  mercury  have  also  been  produced.  The  combination  of  these 
two  metals  in  the  same  substance  may  be  expected  to  lead  to  interest- 
ino"  results.  Promisin^g  results  have  also  attended  the  investigation 
into  the  effect  of  certain  of  these  synthesized  mercurial  compounds 
when  used  intraspinously.  The  different  phases  of  this  research  are 
being  investigated  energetically,  and  there  seems  to  be  much  reason 
for  expecting  valuable  scientific  results.  The  appropriation  for  this 
research  was  made  in  May,  1919,  and  renewed  in  March,  1920. 

5.  "  A  series  of  studies  for  the  recognition  and  diagnosis  of  tre- 
ponema  pallidum  in  venereal  diseases,  and  the  effect  of  various  drugs 
and  materials  as  germicidal  agents  against  treponema  pallidum," 
under  the  direction  of  Dr.  Eandle  C.  Eosenberger,  professor  of 
hygiene  and  bacteriology,  Jefferson  Medical  College  of  Philadelphia, 
with  the  assistance  of  Dr.  John  I.  Fanz.  This  research  was  carried 
out  last  summer  during  the  months  of  June,  July,  August,  and  Sep- 
tember, 1919.  A  detailed  report  of  the  research  has  been  published. 
Drs.  Eosenberger  and  Fanz  introduced  the  use  of  color  screens  in 
examining  preparations  for  the  organisms  of  syphilis  by  means  of 
the  dark  field  illumination,  which  makes  it  much  easier  to  examine 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     119 

secretions  because  of  the  fact  that  the  extreme  brilliancy  of  the 
preparation  is  overcome  and  the  preparation  much  softened  by  sem- 
oval  of  actinic  rays.  Heretofore,  attempts  to  stain  the  organisms  of 
syphilis  in  smears  of  chancre  juice  have  been  rather  tedious  and 
unsuccessful.  By  actually  forming  a  dye  in  the  organism,  it  is 
brought  out  distinctly  in  its  morphology,  so  that  anyone  acquainted 
with  its  peculiarities  can  not  mistake  it  for  any  other  organism. 
This  method  is  loiown  as  the  aniline  black  method  of  Fanz.  A 
method  for  the  intravitam  staining  of  the  treponema  pallidum  has 
also  been  devised  as  the  result  of  this  investigation.  The  report  of 
this  research  also  contains  a  description  of  a  novel  and  new  method 
of  cultivating  the  organism  of  syphilis  in  rabbit  blood.  The  impor- 
tance of  this  investigation  is  at  once  apparent  when  it  is  realized 
that  the  laboratory  diagnosis  of  syphilis  often  hangs  on  the  Wasser- 
mann  reaction  which  can  not  usually  be  made  with  any  degree  of 
reliability  until  the  disease  has  entered  the  secondary'  stage.  The 
investigations  of  Rosenberger  and  Fanz  are,  therefore,  important 
because  they  make  it  easier  to  diagnose  cases  of  syphilis  in  the  first 
stage  when  the  chancre  is  the  only  evidence.  Treatment  given  at  this 
time  helps  catch  the  infection  in  its  incipiency  and  reduces  the  amount 
of  damage  that  is  bound  to  result  unless  the  treponema  pallidum  is 
killed.  Early  recognition  of  the  disease  is  also  important  because  it 
makes  it  possible  to  reduce  the  contagiousness  of  the  infection  and 
limit  it  to  the  individual.  The  appropriation  for  this  research  was 
made  in  June,  1919. 

6.  "An  attempt  to  prepare  mercurial  and  arsenical  compounds 
which  have  a  predilection  for  the  central  nervous  system,  in  the 
hope  of  finding  drugs  more  useful  than  any  known  in  the  treatment 
of  syphilis  of  the  central  nervous  system,"  under  the  direction  of  Dr. 
A.  S.  Loevenhart,  professor  of  pharmacology  and  toxicology,  Uni- 
versity of  Wisconsin  Medical  School.  Associated  with  Dr.  Loeven- 
hart in  this  investigation  are  Dr.  H.  C.  Bradley,  professor  of  physio- 
logical chemistry;  Dr.  P.  F.  Clark,  professor  of  bacteriology;  Dr. 
W.  F.  Lorenz,  professor  of  psychiatry;  and  Dr.  W.  D.  Stovall, 
director  of  the  State  laboratory  of  hygiene.  The  problems  under 
investigation  include  synthetic  chemical  work,  physiologic  chemical 
work,  pharmacological  and  toxicological  work,  pathological  and 
bacteriological  work,  and  clinical  work.  A  report  on  the  synthesis 
of  arsanilic  acid  has  been  published  by  Messrs.  Cheetham  and  Smith 
in  the  Journal  of  the  American  Chemical  Society,  volume  42,  page 
828.  This  substance  is  fundamental  to  the  synthesis  of  many  impor- 
tant arsenical  compounds.  The  Gutzeit  method  for  the  determina- 
tion of  minute  quantities  of  arsenic  has  been  perfected  and  placed  in 
constant  use.  This  phase  of  the  research  is  most  important.  Work 
on  the  rate  of  excretion  will  probably  give  an  excellent  idea  as  to 


120     REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

how  each  drug  should  be  employed  therapeutically.  Several  new 
compounds  have  been  manufactured,  and  at  least  one  new  arsenical, 
namely,  N-arsenetripiperidonium  chloride,  has  been  studied  with 
reference  to  its  toxic  powers.  Three  other  new  arsenicals  are  now 
prepared  and  are  being  investigated.  A  number  of  the  cases  of 
neurosyphilis  have  been  treated  with  new  drugs,  and  in  the  main 
remarkable  improvement  after  a  course  of  treatment  has  been  noted. 
The  cell  count  of  the  cerebrospinal  fluid  fell  to  within  normal,  and 
the  gold  sol  reaction  also  showed  a  change  toward  the  normal.  The 
results  of  this  treatment  have  been  far  superior  to  the  other  treat- 
ment with  salvarsan  and  neosalvarsan.  This  research  will  be  con- 
tinued on  a  large  scale  and  a  great  number  of  cases  treated.  It  may 
be  added  that  the  treatment  is  very  simple  and  involves  no  trouble 
or  inconvenience  to  the  patient.  Thousands  of  cases  of  syphilis 
which  occur  in  the  Army  and  Navy  will  doubtless  develop  paresis  or 
locomotor  ataxia  and  become  completely  dependent  wards  of  the 
State  or  National  Government.  If  this  research  proves  successful, 
it  will  be  possible  to  arrest  and  perhaps  cure  such  cases.  Salvarsan 
and  neosalvarsan  have  been  a  disappointment  for  cases  of  this  nature, 
and  there  is  no  efficacious  treatment  known.  The  details  of  this  new 
treatment  are  being  withheld  until  more  opportunity  has  been  given 
to  thoroughly  test  it  out.  The  appropriation  for  this  research  was 
made  in  June,  1919,  and  renewed  in  June,  1920. 

7.  "A  study  of  hereditary  transmission  of  syphilis,"  under  the 
direction  of  Dr.  P.  C.  Jeans,  associate  professor  of  pediatrics,  Wash- 
ington University  School  of  Medicine,  St.  Louis,  Mo.  This  inves- 
tigation involves  a  study  of  the  clinical  findings  in  infants  and  chil- 
dren, together  with  histological  examination  of  placentae,  and  tes- 
ticular lesions  in  latent  paternal  syphilis.  The  histological  findings 
will  be  checked  up,  whenever  possible,  with  the  Wassermann  reac- 
tion on  the  mother's  serum  and  later  a  clinical  and  serological  exami- 
nation of  the  infant.  The  cooperation  of  the  Barnes,  St.  Louis  City, 
St.  Louis  Maternity,  St.  Luke's,  and  Missouri  Baptist  Sanitarium 
Hospitals  and  the  Washington  University  and  St.  Louis  University 
Dispensaries  has  been  secured.  From  these  institutions  placentae 
and  samples  of  blood  from  the  umbilical  cord  are  collected  daily 
and  examined  in  the  laboratory.  Through  the  cooperation  of  the 
municipal  nurses  of  the  city  it  has  been  possible  to  arrange  for 
"  follow  up  "  of  such  cases  as  seem  advisable.  The  correlation  of  this 
data  has  not  been  completed,  and  it  is  therefore  impossible  to  draw 
any  conclusions  with  reference  to  the  problem  under  consideration. 
The  especial  value  of  this  research  lies  in  the  fact  that  there  is  no 
reliable  method  for  the  early  recognition  of  hereditary  syphilis 
available  for  routine  use.  Even  if  it  were  possible  to  demand  a 
Wassermann  reaction  on  every  newly  born  infant,  about  one-third 


REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.      121 

of  the  infections  would  be  missed  if  this  alone  were  depended  upon. 
The  examination  of  blood  from  the  placental  end  of  the  cord  gives 
about  the  same  incidence  of  negative  reactions  in  positive  cases. 
Neither  does  a  positive  Wassermann  reaction  in  the  mother  prove 
the  child  to  be  syphilitic,  although  it  may  be  valuable  evidence.  It 
is  a  well-recognized  fact  that  the  chances  of  complete  cure  of  syph- 
ilis, whether  hereditary  or  acquired,  steadily  diminish  as  the  inter- 
val between  the  time  of  infection  and  the  time  of  treatment  increases. 
The  waste  in  infant  and  child  life  in  a  large  group  of  syphilitic 
families  is  over  60  per  cent,  as  compared  with  less  than  25  per  cent  in 
a  similar  group  of  nonsyphilitic  families  of  the  same  social  plane. 
A  reliable  method  for  diagnosing  the  presence  of  syphilis  in  the 
new  born  should  be  invaluable,  because  of  the  greater  opportunity 
for  effecting  a  cure  and  also  reducing  the  contagiousness  of  the  case. 
The  appropriation  for  this  research  was  made  in  June,  1919. 

8.  "An  investigation  of  the  properties  contributing  to  the  toxicity 
of  arsphenamine,  neoarsphenamine,  and  analogous  products,"  under 
the  direction  of  Dr.  Eeid  Hunt,  professor  of  pharmacology.  Harvard 
University  Medical  School,  assisted  by  W.  G.  Christiansen.  This 
research  involves  the  preparation  of  arsphenamine  by  all  known 
methods  and  some  new  methods.  These  products  are  examined,  not 
only  the  final  product  but  the  products  formed  during  the  manufac- 
ture. The  various  reagents  employed  during  the  manufacture  of 
these  compounds  are  examined  to  determine  at  what  stage  and 
through  the  interaction  of  what  reagents  the  poisonous  principles  are 
formed.  The  problem  is  one  of  great  difficulty,  as  is  evident  from  the 
fact  that  a  number  of  the  leading  investigators  of  Great  Britain, 
France,  and  Germany  have  failed  to  solve  it.  Very  material  progress 
seems  to  have  been  made,  however,  in  the  research  that  Dr.  Hunt  is 
directing.  Many  possibilities  have  been  eliminated  and  the  field  for 
further  investigation  has  been  narrowed.  The  value  of  this  research 
lies  in  the  fact  that  a  successful  solution  of  the  problem  under  investi- 
gation will  result  in  more  effective  treatment  for  syphilis,  for  it  will 
be  possible  to  give  larger  doses  and  at  shorter  intervals.  The  course 
of  the  disease  will  be  shortened,  and  what  is  of  even  greater  im- 
portance, the  period  during  which  an  individual  can  infect  others 
will  be  shortened.  Incidentally  the  cost  of  the  drug  will  be  lowered. 
The  appropriation  for  this  research  was  made  in  June,  1919,  and 
renewed  in  March,  1920.  A  paper  embodying  some  of  the  results 
obtained  is  in  press  (Journal  American  Chemical  Society),  and 
others  are  in  preparation. 

9.  "A  study  of  the  effect  of  radiant  energy  upon  experimental 
syphilis  in  the  rabbit,"  under  the  direction  of  Dr.  George  S.  Graham, 
professor  of  pathology,  and  Dr.  W.  M.  Baldwin,  professor  of  anat- 
omy, Union   University  Medical    School,  Albany,  assisted  by   Dr. 


122      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

William  R.  Whitney,  director  of  the  research  laboratory  of  the 
General  Electric  Co.,  Schenectady,  N.  Y.  It  seems  probable  that  a 
thorough  study  of  the  biological  and  pathological  characters  of 
syphilis  induced  in  lower  animals  will  lead  to  more  effective  medical 
measures  in  the  prevention  and  treatment  of  venereal  diseases  in 
man.  This  research  involves  the  subjection  of  animals  to  carefully 
measured  X-ray  exposures  before  and  after  intratesticular  inocula- 
tion with  spirochete  containing  material  obtained  from  rabbits  with 
syphilitic  orchitis,  Nonrayed  animals  are  used  as  controls.  Dr. 
Graham  reports  that  he  has  been  successful  in  producing  widespread 
syphilitic  lesions  in  rabbits  which  gave  typical  Wassermann  reac- 
tions in  about  four  weeks.  This  work  has  been  supplemented  by 
daily  examination  of  the  blood  (total  and  differential  leucocyte 
counts),  observation  of  gross  lesions  and  histological  study  of  the 
inoculated  testis  at  varying  periods,  and  of  the  various  organs  after 
death.  The  freedom  of  experimentally  infected  animals  from  the 
intercurrent  diseases  common  to  man  will  make  it  much  easier  to 
study  the  serology  and  pathology  of  the  venereal  diseases,  for  the 
investigator  will  not  have  to  contend  with  disease  manifestations  due 
to  infections  other  than  the  particular  infection  that  is  being  studied. 
It  is  also  proposed  to  make  a  study  of  the  therapeutic  effect  of  certain 
physical  agents  on  the  lesions  produced  by  experimental  inoculation 
with  the  organism  of  syphilis,  such  as  the  X  ray  and  the  ultra-violet 
rays.  The  appropriation  for  this  research  was  made  in  June,  1919. 
10.  "  Investigation  of  the  chemical  and  physical  properties  of  the 
cerebrospinal  fluid  in  the  luetic  and  the  nonluetic,"  under  the  direc- 
tion of  Dr.  L.  G.  Rowntree,  chief  of  the  department  of  medicine, 
University  of  Minnesota  Medical  School,  assisted  by  Dr.  Grete 
Egerer  and  Dr.  C.  E.  Nixon.  This  investigation  relates  to  the  fol- 
lowing problems :  (a)  The  character  of  the  ultra-filtrates  from  luetic 
(syphilitic)  blood,  and  (&)  the  determination  of  the  factors  affecting 
the  colloidal  gold  curve  of  cerebrospinal  fluid  and  of  the  ultra- 
filtrates  from  luetic  blood,  and  (c)  the  chemical  constituents  of  blood 
in  luetic  and  non-luetic  individuals.  Problem  (h)  includes  the  deter- 
mination of  the  acid  base  equilibrium,  the  globulin  content,  the  salt 
content,  the  effects  of  dilution  to  the  vanishing  point  of  the  colloidal 
gold  curve,  and  the  effects  of  concentration.  The  object  of  the  first 
investigation  is  to  ascertain  whether  or  not  a  reliable  method  can  be 
developed  for  obtaining  luetic  gold  chloride  curves  from  the  ultra- 
filtrates  of  blood  which  correspond  to  the  colloidal  gold  curve  of 
the  cerebrospinal  fluid.  It  is  obvious  that  success  in  this  particular 
problem  will  result  in  a  tremendous  addition  to  the  diagnostic 
methods  of  recognizing  syphilis.  The  ultra-filtrate  apparatus  used 
is  a  modification  of  the  Bechols  pressure  apparatus.  Problem  "(c) 
involves  investigations  relative  to  the  sugar,  urea,  and  creatinin  con- 


REPORT  V.  S.  INTERDEPARTMENTAX,  SOCIAL  HYGIENE  BOARD.     123 

tent,  and  enzymatic  activity  of  the  cerebrospinal  fluid  in  luetic  and 
non-luetic  individuals.  The  appropriation  for  this  research  was 
made  in  June,  1919,  and  renewed  in  April,  1920. 

11.  "  Studies  on  the  nature  of  the  Wassermann  reaction,"  under  the 
-direction  of  Dr.  Thomas  Ordway,  dean  and  associate  professor  of 
medicine.  Union  University  Medical  School,  assisted  by  Dr.  Arthur 
Knudson,  associate  professor  of  biological  chemistry;  Walter  K. 
Grigg,  M.  M.  Lee,  John  C.  Younie,  Jean  Tait,  and  Hazel  Ferguson. 
This  research  involves  a  chemical  examination  of  the  fat  content  of 
the  blood,  both  corpuscles  and  plasma,  in  syphilitic  bloods  having 
Wassermann  reactions  of  various  degrees,  and  negative  control  cases, 
supplemented  by  certain  physico-chemical  examinations.  The  pur- 
pose of  the  investigation  is  to  determine  whether  the  Wassermann 
reaction  is  a  specific,  so-called  "  immunity  reaction,"  or  a  delicate 
biological  indication  which  represents  measurable  chemical  changes 
in  the  body  fluids  as  a  result  of  syphilitic  infection.  This  work  is 
to  be  supplemented  by  studies  on  the  Wassermann  reaction  in  experi- 
mental animals  that  have  been"  inoculated  with  syphilis.  This  re- 
search aims  at  the  explanation  of  the  Wassermann  reaction,  so  that 
it  will  be  possible  to  improve  the  technic  and  make  the  reaction  more 
reliable.     The  appropriation  was  granted  in  June,  1919. 

12.  "  The  demonstration  of  the  syphilitic  nature  of  unusual  lesions 
encountered  at  the  post-mortem  table,"  under  the  direction  of  Dr. 
M.  C.  Winternitz,  professor  of  pathology  and  bacteriology,  Yale 
University  Medical  School,  assisted  by  Dr.  Frank  P.  McNamara  and 
Miss  Alice  Thing.  This  study  involves  an  attempt  to  demonstrate 
the  specific  nature  of  unusual  lesions  of  syphilis.  The  gross  appear- 
ance and  the  histology  of  lesions  are  correlated  with  the  bacteriology. 
Attempts  are  made  to  demonstrate  the  treponema  pallidum  by  the 
dark-field  method,  but  more  especially  by  the  Levaditi  method  and 
its  various  modifications.  By  demonstrating  the  syphilitic  nature 
of  unusual  lesions  and  unusual  clinical  manifestations  of  disease,  it 
will  be  possible  to  diagnose  more  accurately  future  cases  with  similar 
clinical  pictures.  Such  knowledge  naturally  leads  to  more  prompt 
and  rational  treatment,  and  incidentally  (but  of  great  importance) 
to  a  shortening  of  the  period  of  contagiousness  of  the  disease  for 
others.  Considerable  material  has  been  examined  in  connection  with 
its  clinical  history  and  the  syphilitic  nature  of  many  of  the  unusual 
lesions  demonstrated.  The  appropriation  for  this  research  was  made 
in  June,  1919. 

13.  "A  study  of  syphilis  in  pregnant  women  and  new-born  children 
with  special  reference  to  the  efficacy  of  methods  of  diagnosis  and 
treatment,"  under  the  direction  of  Dr.  Bertha  M.  Meine,  director  of 
the  research  department.  Woman's  Medical  College  of  Pennsylvania, 
in  collaboration  with  Dr.  Rose  Herschler.     Married  women  and  chil- 


124      REPORT  V.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

dren  constitute  the  larger  percentage  of  people  who  acquire  syphilis 
innocently.  The  enormity  of  their  number  makes  it  especially  im- 
portant that  an  investigation  be  made  with  reference  to  the  efficacy 
of  methods  of  treating  and  diagnosing  these  cases.  Many  of  these 
cases  go  untreated  and  become  a  danger  to  others,  unless  they  are 
given  the  benefit  of  modern  laboratory  service.  Much  reliability 
has  been  placed  on  the  Wassermann  reaction  where  it  could  be  given. 
Cases  that  have  not  been  given  this  serological  test  have  been  diag- 
nosed on  their  clinical  history,  the  examination  of  the  placenta,  a 
serological  test  of  the  placental  blood,  or  the  physical  appearance  of 
the  child.  This  research  aims  to  establish  the  value  of  these  different 
methods  of  diagnosis.  Furthermore,  it  is  concerned  with  an  investi- 
gation into  the  treatment  of  cases  having  syphilis.  The  investiga- 
tions that  have  been  carried  on  to  date  seem  to  indicate  that  the  ex- 
amination of  the  placenta  does  not  give  a  reliable  diagnosis  of 
syphilis ;  neither  does  it  appear  that  the  Wassermann  reaction  on  the 
placental  blood  is  reliable.  The  value  of  treating  pregnant  syphilitic 
women  varies,  as  might  be  expected,  with  the  promptness  of  the 
treatment.  Every  case  should  be  given  treatment  before  the  eighth 
month,  and  as  much  earlier  as  possible.  Considerable  work  has  also 
been  done  on  the  treatment  of  new-born  children  who  are  syphilitic. 
The  appropriation  for  this  research  was  made  in  June,  1919. 

14.  "  The  laboratory  (biological)  investigation  of  the  latent 
syphilitic  as  a  carrier,"  under  the  direction  of  Dr.  M.  F.  Engman, 
chief  of  the  department  of  dermatology,  Washington  University 
School  of  Medicine,  St.  Louis,  Mo.,  conducted  by  Dr.  F.  Eberson, 
chief  of  laboratory,  assisted  by  Drs.  F.  M.  Jacob,  E.  S.  Weiss,  and  H. 
Gaebe.  This  research  aims  to  investigate  the  possibility  of  the  latent 
syphilitic  as  a  carrier  of  infection  by  a  study  of  the  infectivity  of 
semen,  blood,  lymphatic  glands,  spinal  fluid,  and  nasal  washings  from 
authentic  cases  of  latent  syphilis.  These  materials  are  injected  into 
rabbits'  testes  to  determine  the  presence  of  spirocheta  pallida.  It 
appears  that  the  blood  and  other  body  fluids,  excepting  semen,  are  not 
infectious  in  latent  syphilis,  or  if  so  but  rarely.  In  a  few  instances 
the  inguinal  glands  have  been  found  to  contain  active,  virulent 
spirocheta  pallida.  There  are  certain  parts  of  the  body  which  act  as 
reservoirs  from  which  the  organisms  causing  syphilis  may  be  dis- 
charged at  intervals.  The  latent  syphilitic  may  be  a  carrier  and  a 
source  of  danger  in  transmitting  syphilis  to  offspring  and  to  a  com- 
munity. In  the  absence  of  frank  lesions  of  syphilis,  such  as  the 
causes  in  this  study  proved,  the  carrier  state  is  of  inestimable  danger 
owing  to  the  fact  that  latency  is  of  much  longer  duration  than  all 
other  stages  combined,  and  ignorance  on  the  part  of  a  patient  tends 
inevitably  to  neglect  in  treatment.  The  appropriation  for  this  re- 
search was  made  in  September,  1919. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      125 

15,  "All  investigation  of  the  family  of  the  syphilitic,"  under  the 
direction  of  Dr.  H.  C.  Solomon,  Massachusetts  State  Psychiatric  In- 
stitute. This  research  involves  a  studj^  of  the  social  and  economic 
effects  of  syphilis  in  special  relation  to  the  family.  The  clinical  ma- 
terial available  to  the  Massachusetts  Psychiatric  Institute  will  make 
it  possible  to  establish  a  workable  plan  for  studying  syphilis  of  the 
innocent.  Unfortunately,  syphilis  is  a  concern  to  many  who  have  in 
no  way  transgressed.  Contrary  to  the  usual  conception  of  the  word, 
syphilis  as  a  venereal  disease  occurs  only  in  a  percentage  of  the  cases ; 
many  cases  are  innocently  acquired.  The  especial  value  of  this  re- 
search lies  in  the  fact  that  it  wnll  shed  light  on  the  proper  method  for 
handling  the  syj^hilitic  family  for  the  treatment  of  those  already  in- 
fected and  for  the  prevention  of  further  spread  of  the  disease.  The 
investigation  emphasizes  the  importance  of  making  examinations  of 
all  members  of  the  family  where  one  is  infected  with  syphilis. 
Unless  this  is  done,  many  cases  of  syphilis  are  missed  which  later 
become  serious  problems  to  the  community.  By  far  the  larger  part 
of  money  spent  for  the  control  of  the  venereal  diseases  is  spent  for 
maintenance  of  people  who  have  passed  the  stage  in  which  help  is 
possible.  A  very  small  part  is  spent  for  the  really  promising  part  of 
the  program,  i.  e.,  prevention  and  early  treatment.  The  educational 
service,  as  well  as  the  medical  and  social  value  of  research  of  this 
type,  is  very  great  for  it  will  give  an  entirely  new  idea  of  the  amount 
of  "  syj)hilis  of  the  innocent "  there  is.  The  appropriation  for  this 
research  was  made  in  October,  1919. 

16.  "An  investigation  of  the  changes  produced  in  the  central  nerv- 
ous system  by  the  treatment  of  cases  of  neurosyphilis,"  under  the 
direction  of  Dr.  H.  C.  Solomon,  Massachusetts  State  Psychiatric 
Institute,  assisted  by  Dr.  M.  H.  Hirschfeld,  Dr.  L.  J.  Thompson, 
and  Dr.  Bernice  Bartlett.  The  value  of  treatment  of  cases  of  neuro- 
syphilis is  a  disputed  point.  This  research  aims  to  shed  light  on  the 
question.  An  analysis  will  be  made  of  data  secured  from  the  treat- 
ment of  approximately  400  cases  of  general  paresis,  all  of  which  have 
been  carefully  controlled  b}^  serological  examinations  and  carefully 
charted  as  to  their  treatment  and  condition.  This  analysis  will 
include  the  duration  of  life,  the  frequency  of  remissions,  the  length 
of  remissions,  and  the  serological  changes.  The  data  will  be  com- 
pared with  control  groups  having  received  no  treatment.  .  An  ex- 
amination of  the  brains  of  cases  that  have  received  antisyphilitic 
treatment  is  being  made  to  see  if  the  cases  that  have  received 
treatment  show  a  different  type  of  pathology  from  those  that  have 
been  untreated.  The  clinic  of  the  Massachusetts  State  Psychiatric 
Institute  is  one  of  the  most  elaborate  of  the  neurosyphilitic  clinics 
to  be  found  anywhere  in  the  world  at  the  present  time.  The  amount 
of  autopsied  material  therein  is  imiqiie  and  its  quality  very  special 


126      REPOKT  U.  S.  INTEKDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

on  account  of  the  uniform  methods  of  observation  of  material,  and 
especially  on  account  of  the  availability  of  all  the  spinal  cords  as 
well  as  the  brains  and  other  tissues  of  the  cases.  The  progress  of 
the  study  that  is  being  made  here  indicates  that  valuable  information 
as  to  the  treatment  of  various  sorts  wiU  be  obtained.  The  api^ro- 
priation  for  this  research  was  made  in  October,  1919. 

17.  "A  synthesis  of  organic  compounds  containing  arsenic  of  pos- 
sible value  in  the  treatment  of  syphilis  of  the  central  nervous  sys- 
tem," under  the  direction  of  Dr.  W.  Lee  Lewis,  professor  of  chem- 
istry. Northwestern  University,  assisted  by  Messrs.  C.  D,  Lowry, 
Frank  H.  Bergeim,  Harold  C.  Cheetham,  and  C.  S.  Hamilton.  The 
research  proposed  above  is  a  part  of  a  carefully  organized  plan 
whereby  the  new  chemical  compounds  that  may  be  synthesized 
through  the  efforts  of  Dr.  Lewis  and  his  associates  will  be  tested  for 
their  therapeutic  values  in  relation  to  the  treatment  of  syphilis  under 
Dr.  A.  S.  Loevenhart,  director  of  the  department  of  pharmacology 
and  toxicology.  University  of  Wisconsin.  Some  12  new  arsenicals 
have  been  synthesized,  being  simple  derivatives  of  diphenoxychlo- 
rasine.  Three  compounds  have  been  sent  to  Dr.  Loevenhart,  of  the 
University  of  Wisconsin,  for  tests,  and  two  others  are  being  finished 
that  should  be  of  interest  pharmacologically.  This  work  will  be 
extended  this  fall.  Mention  might  also  be  made  here  of  the  im- 
proved method  which  Messrs.  Cheetham  and  Schmidt  have  discov- 
ered at  the  University  of  Wisconsin  for  the  preparation  of  pri- 
mary arsanilic  acid,  the  foundation  for  all  present-day  arsenicals 
used  in  the  treatment  of  syphilis.  The  special  importance  of  this 
improved  method  lies  in  the  fact  that  it  promises  to  reduce  the  cost 
of  the  drug  and  also  to  decrease  the  length  of  time  taken  in  its  manu- 
facture. These  two  factors  are  important  considerations  in  the  con- 
trol of  the  venereal  disease  group.  The  appropriation  for  this 
research  was  made  in  November,  1919. 

18.  "The  preparation  of  new  organic  compounds  which  may  have 
therapeutic  value,"  under  the  direction  of  Dr.  Roger  Adams,  pro- 
fessor of  organic  chemistrj^.  University  of  Illinois,  assisted  by  Messrs. 
J.  R.  Johnson,  C.  S.  Palmer,  and  J.  L.  Hall.  This  research  deals 
with  the  preparation  of  new  arsenic  compounds  which  are  to  be 
tested  by  Dr.  A.  S.  Loevenhart,  director  of  the  department  of  phar- 
macology and  toxicology.  University  of  Wisconsin,  who  is  collaborat- 
ing with  Dr.  Adams.  A  third  phase  of  this  work  is  being  conducted 
at  Northwestern  University,  where  Dr.  W.  Lee  Lewis,  professor  of 
chemistry,  is  investigating  the  manufacture  of  new  organic  com- 
pounds containing  arsenic  for  a  similar  purpose.  This  research  com- 
bines the  scientific  activities  of  three  universities  in  the  field  of 


KEPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD.      127 

organic  chemical  compound  synthesis,  and  is  being  carried  out  with 
no  little  promise  of  success.  The  problems  being  studied  by  Dr. 
Adams  consist  of  the  investigation  of  compounds  of  arsenic  which 
are  neutral  in  character,  soluble  in  water,  but  not  of  the  salt  type. 
There  are  three  different  series  which  it  is  hoped  may  be  developed, 
all  of  which  should  have  the  properties  mentioned,  and  none  of  which 
have  been  investigated  up  to  this  time.  These  new  compounds  of 
arsenic  should  be  very  stable  in  solution  so  that  they  can  be  easily 
sterilized  and  thus  avoid  the  dangers  which  are  now  involved  in 
the  use  of  salvarsan.  In  addition  they  may  prove  useful  in  the  dis- 
eases of  the  central  nervous  system  for  which  purpose  salvarsan  can 
not  be  used.  The  appropriation  for  this  research  was  made  in  Febru- 
ary, 1920. 

19.  "  Synthesis  of  new  substances  of  the  general  type  R-HG-0. 
CO.  H'  with  variations  to  make  new  drugs  more  suited  to  their  use  in 
syphilis  and  in  gonorrhea,"  under  the  direction  of  Dr.  Frank  C. 
Whitmore,  department  of  chemistry.  Northwestern  University,  as- 
sisted by  Virgil  E.  Meharg  and  Edmund  B,  Middleton.  The  syn- 
thetic chemical  work  connected  with  this  research  will  be  done  by  a 
group  of  trained  organic  chemists,  all  of  whom  have  had  consid- 
erable experience  in  chemical  work  with  organic  mercury  compounds. 
The  substances  prepared  in  this  laboratory  are  to  be  tested, for  valu- 
able pharmacological  properties  by  a  staff  of  expert  pharmacologists, 
physiological  chemists,  and  clinical  physicians  working  under  the 
direction  of  Dr.  A.  S.  Loevenhart  at  the  University  of  Wisconsin. 
Chemical  modifications  of  the  substances  manufactured  under  the 
direction  of  Dr.  Whitmore  will  be  made  if  the  investigations  under 
Dr.  Loevenhart  seem  to  indicate  such  steps  to  be  worth  while.  The 
work  has  not  been  carried  on  far  enough  to  make  it  possible  to  report 
more  in  detail  on  this  investigation.  The  appropriation  for  this 
research  was  made  in  February,  1920.  Work  was  started  June  15, 
1920. 

20.  "A  study  of  hereditary  syphilis  with  particular  reference  to 
the  progress  of  the  disease  in  the  individual  and  the  effect  of  treat- 
ment," under  the  direction  of  Dr.  Borden  S.  Veeder,  professor  of 
clinical  pediatrics,  Washington  University  School  of  Medicine,  St. 
Louis.  It  is  proposed  to  make  a  clinical-social  study  of  a  large  num- 
ber of  cases  of  hereditary  syphilis  to  find  out  what  occurs  when 
syphilis  is  transmitted  from  parent  to  child.  No  such  study  has  been 
made  as  a  vs^hole  since  the  development  of  the  Wassermann  reaction 
and  other  modern  phases  of  syphilis.  The  exact  physical  and  mental 
condition  of  syphilitic  children  will  be  determined  and  compared 
with  a  group  of  non-luetic  children  of  the  same  social  standing  and 


128      REPOKT  U.  S.  IlS^TERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD. 

environment.  This  study  will  include  the  types  and  nature  of  physi- 
cal abnormalities,  mental  deficiency,  results  of  treatment,  death  rate 
in  infanc}^  and  childhood,  etc.  The  department  of  pediatrics  of  the 
Washington  University  Medical  iSchool  possesses  an  abundance  of 
material  for  this  research.  During  the  last  eight  years  approxi- 
mately 500  cases  of  hereditary  syphilis  have  been  carefully  examined, 
and  to  a  greater  or  less  degree  received  treatment.  It  is  proposed 
to  go  over  this  entire  material,  looking  up  every  case,  and  examining 
ever}^  living  child  in  the  clinic  or  home  as  to  its  physical  and  mental 
condition,  including  laboratory  tests.  A  research  of  this  type  should 
throw  light  on  the  controversy  as  to  whether  or  not  hereditary 
syphilis  is  amenable  to  treatment,  and,  secondly,  as  to  whether,  even 
if  thoroughly  treated,  hereditary  syphilitics  do  not  belong  to  a  per- 
manently defective  class.  The  appropriation  for  this  research  was 
made  in  February,  1920. 


Up  to  June  30, 1920,  preliminary  reports  have  been  published  of  the 
following:  investigations  which  have  been  made  with  the  aid  of  funds 
granted  by  the  United  States  Interdepartmental  Social  Hygiene 
Board   for  research   in  the   prevention  and  treatment  of   venereal 

diseases : 

"A  new  germicide  for  use  in  tlie  genito-uriuary  tract :  Mercurocliroiue  220." 
A  preliminary  report  of  experimental  and  clinical  studies  carried  on  in  the 
James  Buchanan  Brady  Urological  Institute,  Johns  Hopkins  Hospital,  by  Hugh 
H.  Young,  M.  D.,  Edwin  C.  White,  Ph.  D.,  and  Ernest  O.  Sv.'artz,  M.  D.,  Johns 
Hopkins  University. 

"A  series  of  studies  for  the  recognition  and  diagnosis  of  treponema  pallidum 
in  venereal  diseases,  and  the  effect  of  various  drugs  and  materials  as  germicidal 
agents  against  treponema  pallidum,"  conducted  by  Dr.  Randle  C.  llosenberger 
and  Dr.  John  I.  Fanz,  of  the  John  H.  McPadden  Research  Laboratory  of  the 
Jefferson  Medical  College,  Philadelphia,  Pa. 

"A  more  rapid  and  improved  method  of  demonstrating  spirochaetes  in  tis- 
sues," by  Aldred  Scott  Warthin,  M.  D.,  professor  of  pathology,  and  Allen  O. 
Starry,   research  assistant  in  pathology,  University  of  Michigan,  Ann  Arbor. 

"An  improved  method  for  the  preparation  primary  arsanilic  acid,"  by 
Harold  C.  Cheetham  and  John  H.  Schmidt,  of  the  chemical  laboratory  of  the 
University  of  Wisconsin. 

"A  simplified  plate  method  of  partial  oxygen  tension  in  the  cultivation  of  the 
g'onococcus,"  by  Russell  D.  Herrold,  M.  D.,  of  the  John  McCormick  Institute  for 
Infectious  Diseases. 

"  Further  observations  on  acriflavine  in  gonorrhea,"  by  Edwin  G.  Davis. 
M.  D.,  University  of  Nebraska. 


REPORT  U.  S.  INTERDEPARTMENTAX,  SOCIAL  HYGIENE  BOARD.      129 
Data  on  scientific  resea/rch  fund. 


state  and  institution. 


Amount  of  appro- 
priation. 


1919 


1920 


Number 

of  re- 
searches. 


Scientists 

in 

charge. 


Assisting 

profes- 
sors, tech- 
nicians, 
social 
workers, 
etc. 


California: 

Leland  Stanford  Junior  University 

University  of  California 

Connecticut :  Yale  University 

Illinois: 

John  McCormick  Institute 

Northwestern  University 

University  of  Illinois 

Iowa:  State  University  of  Iowa 

Maryland:  Johns  Hopkins  University 

Massachusetts: 

Harvard  University 

Massachusetts  State  Psychiatric  Institute. 

Michigan:  University  of  Michigan 

Minnesota:  University  of  Minnesota 

Missouri: 

St.  Louis  University 

Washington  University 

Nebraska:  University  of  Nebraska 

New  York: 

Columbia  University 

Cornell  University 

New  York  University 

Union  University 

Pennsylvania: 

Women's  Medical  College 

Jefferson  Medical  College 

Wisconsin :  Universit v  of  Wisconsin 


$7, 200 

'  '4,' 666 


3,875 


19,050 
7,000 


6,000 
8,250 

3,000 
13, 200 
5,000 


3,000 
6,000 
3,500 
5,320 
19, 050 

10,000 
13, 200 


7,440 

4,' 380' 

1,550 
2,500 
8,000 


9,000 

4,000 
4,000 

4,200 

5,400 

12,000 


4 
13 
14 


Total  (13  States,  22  institutions) . 
Joint 


96,570       103,430 
200,000 


1  Includes  research  at  Jefferson  Medical  College  which  was  completed  in  the  summer  of  1919. 
Note. — The  number  of  persons  engaged  in  these  researches  does  not  include  clerks,  stenographers,  dieners, 
etc.    It  represents  the  trained  personnel  only. 

SUMMARY. 
Board  began  making  appropriations  for  researches,  March,  1919. 

Number  of  researches  assisted  during  fiscal  year  1919 25 

Number  of  new  researches  started  during  fiscal  year  of  1920 11 

Number  of  old  researches  assisted  during  fiscal  year  of  1920 11 

Number  of  institutions  represented  in  the  board's  36  researches 22 

Number  of  States  represented 13 

Number  of  scientists  in  direct  charge  of  investigations 40 

Number  of  trained  assistants  (professors,  technicians,  social  workers) 98 

Cost  of  researches  during  fiscal  years  1919-20 ?200,  000 

Number  of  researches  completed 1 

Number  of  preliminary  reports  published 6 

Number  of  preliminary  reports  ready  to  go  to  press 6 

Number  of  researches  proposed  to  the  board  and  found  unsuitable 44 

Number  of  researches  now  in  progress 35 

REPORT  ON  THE  DIVISION  OF  EDUCATIONAL  RESEARCH  AND 

DEVELOPMENT. 

1.   PRINCIPLES   AND   REGULATIONS. 


The  report  for  last  year   (1918-19)   included  a  statement  of  the 
principles  by  which  the  Interdepartmental  Social  Hygiene  Board 
would  be  governed  in  the  administration  of  the  fund  intrusted  to  it 
15610—20 9 


130      EEPOET  U.  S.  INTEKDEPAKTMENTAL  SOCIAL  HYGIENE  BOARD. 

by  Congress  "  for  the  purpose  of  discovering  and  developing  more 
effective  educational  measures  in  the  prevention  of  venereal  disease^ 
and  for  the  purpose  of  sociological  and  psychological  research  re- 
lated thereto." 

Briefly  summarized,  these  principles  are  as  follows :  A  program 
should  be  formulated  that  would  lead  to  permanency  of  educational 
influence  and  reach  the  child  in  the  home  and  the  pupil  in  the  school ; 
the  permanent  and  self-perpetuating  factor  is  an  increasing  number 
of  informed,  self-respecting  and  self-reliant  persons,  who  as  teach- 
ers, parents,  and  community  leaders  will  exert  influence  in  the  schools, 
in  the  family,  and  in  every  educational  agency  in  society;  normal 
schools,  colleges,  and  universities  are  the  sources  from  which  come 
college  professors,  school  superintendents,  school  principals,  and 
teachers  in  elementary  and  secondary  schools,  and  in  general  the  grad- 
uates of  normal  schools,  colleges,  and  universities  become  citizens  of 
position  and  influence,  who  are  thus  directly  or  indirectly  teachers 
in  the  community,  in  the  school,  and  in  the  home ;  relative  permanency 
of  influence  therefore  will  be  secured  by  establishing  departments  of 
hygiene  in  such  institutions  in  the  various  activities  of  which  "  due 
and  appropriate  emphasis  is  given  to  the  venereal  diseases,"  and  in 
which  the  personnel  for  each  activity  included  in  the  program  of 
such  departments  of  hygiene  will  be  selected  with  special  reference 
to  its  ability  to  handle  successfully  problems  in  venereal  diseases 
that  may  be  logically  considered  by  the  group  of  students  taking 
part  in  that  activity;  such  institutions,  carefully  selected  and  left 
free  to  develop  methods  and  materials  most  likely  to  fit  the  special 
needs  in  their  respective  student  bodies,  will  actually  be  engaged  in 
carrying  out  researches  for  the  discovery  and  development  of  more 
effective  educational  measures  in  the  prevention  of  venereal  diseases. 

The  rules  and  regulations  adopted  by  the  board  to  govern  the  fund 
provided  by  Congress  for  educational  research  and  development  are 
in  conformity  with  these  principles.  The  policy  therefore  was 
adopted  by  the  board  of  making  allotments  to  normal  schools,  col- 
leges, and  universities  for  the  purpose  of  establishing  departments 
of  hygiene  in  conformity  with  the  general  plan  of  organization  out- 
lined in  the  rules  and  regulations. 

In  fulfillment  of  the  authorization  to  assist  colleges,  universities, 
or  other  suitable  institutions  "  in  sociological  and  psychological  re- 
searches related  to  better  educational  measures  in  the  prevention  of 
venereal  diseases,"  the  board  has  adopted  the  policy  of  limiting  allot- 
ments from  this  fund  to  a  very  few  proposals  which  promise  sub- 
stantial results. 

In  this  report  are  presented  the  more  important  facts  in  regard  to 
the  administration  of  this  fund.  The  following  topics  are  consid- 
ered :  The  number,  purpose,  and  disposition  of  applications  for  assist- 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     131 

ance  from  the  educational  research  and  development  fund ;  the  num- 
ber, amounts,  purpose,  and  distribution  of  allotments  from  this 
fund;  the  administrative  relations  between  the  board  and  cooperat- 
ing departments  of  hygiene;  provision  for  administrative  functions 
incident  to  this  fund;  progress  in  organization  of  departments  of 
hygiene;  j^rogress  in  putting  into  effect  the  program  of  instruction 
and  training;  progress  in  developing  better  educational  methods; 
indirect  influence  through  departments  of  hygiene;  sociological  and 
psj^chological  researches. 

2.    APPLICATIONS    FOR     ASSISTANCE    FROM     THE     EDUCATIONAL    RESEARCH 
AND    DEVELOPMENT    FUND — NUMBER,   PURPOSE,   AND   DISPOSITION. 

This  fund  became  actually  available  only  after  the  adoption  of  the 
rules  and  regulations  in  January,  1919.  The  report  of  last  year 
covered  only  the  initial  stages  in  the  operation  of  this  fund  under 
these  rules.  It  seems  desirable,  therefore,  at  this  time  to  summarize, 
for  the  entire  period  from  January,  1919,  to  June  30,  1920,  the  im- 
portant facts  in  regard  to  the  number,  purpose,  and  disposition  of 
applications  for  assistance  from  this  fund. 

(1)  During  the  18  months  the  fund  has  been  available  applica- 
tions for  assistance  have  been  received  from  96  institutions  and  or- 
ganizations. Of  these,  74  were  for  the  purpose  of  establishing 
departments  of  hygiene  in  normal  schools,  colleges,  and  universities ; 
11  were  for  the  purpose  of  special  demonstrations  of  social-hygiene 
instruction  in  summer  schools ;  8  were  for  the  purpose  of  sociological 
and  psychological  researches ;  ^  3  were  for  cooperation  of  State  uni- 
versities with  State  departments  of  education  in  establishing  divisions 
of  educational  hygiene  in  State  departments  of  education. 

(2)  Allotments  have  been  made  to  41  of  the  74  institutions  apply- 
ing for  departments  of  hygiene ;  to  10  of  the  11  summer  schools ;  for 
5  of  the  8  researches;  and  for  2  of  the  3  State  divisions  of  educational 
hygiene. 

(3)  Failure  of  applications  to  secure  allotments  has  been  due  to  a 
variety  of  causes.  Of  the  33  unfruitful  applications  for  departments 
of  hygiene  none  were  rejected  unconditionally.  In  a  large  majority 
of  cases,  the  first  application  was  made  with  insufficient  understand- 
ing of  the  implications  of  the  agreements  pledged  in  the  application. 
With  full  understanding  of  these  implications,  some  institutions 
found  themselves  unable  to  fulfill  the  obligations  and  withdrew  their 
applications;  some  decided  to  postpone  pressing  their  applications 
until  a  later  time ;  some  were  never  heard  from.    Three  research  ap- 


1  Two  of  these  applications  covered  series  of  research  projects,  each  one  of  which  might 
properly  be  regarded  as  an  independent  research.  So  regarded,  the  number  of  research 
applications  would  be  20  instead  of  8,  and  the  number  of  allotments  would  be  17  instead 
of  5. 


132      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

plications  failed  to  mature.  In  two  cases  the  purpose,  scope,  and 
method  of  the  proposed  research  were  not  well  enough  defined  to 
justify  an  allotment.  In  the  other  case  the  negotiations  failed  on 
account  of  the  inability  of  the  institution  to  assume  a  part  of  the  finan- 
cial burden  involved.  One  summer  school  application  was  rejected. 
One  application  for  a  State  division  of  educational  hygiene  is  pend- 
ing. 

(4)  Of  the  74  applications  for  departments  of  hygiene,  44  were 
received  before  January  1,  1920.  Twenty-nine  of  the  44  were  ap- 
proved and  allotments  were  made,  to  be  effective  in  the  academic  year 
1919-20;  one  returned  the  allotment  after  it  was  paid.  Between 
January,  and  June  30,  1920,  30  were  received.  Of  these,  12  were  ap- 
proved and  allotments  were  made  to  be  effective  in  the  academic  year 
1920-21.  In  addition  to  these  original  applications,  there  were  28 
applications  for  continuance  of  assistance ;  of  these  27  were  approved ; 
approval  of  one  was  withheld  pending  receipt  of  additional  informa- 
tion. Of  the  11  summer  school  applications  7  were  for  the  summer 
of  1919 — all  approved;  and  4  for  the  summer  of  1920' — 3  approved 
and  1  rejected.  Of  the  8  researches,  5  were  for  the  year  1919-20 — 
2  approved  and  3  rejected;  and  3  for  the  year  1920-21 — all  approved. 
The  3  applications  for  State  divisions  of  educational  hygiene  were 
all  for  the  year  1920-21. 

(5)  The  preceding  facts  in  regard  to  applications  for  assistance 
from  the  educational  research  and  development  fund  are  shown  in 
summary  as  follows: 

TaMilar  summary  applications  and  allotments  to  June  30,  1920. 

Total  applicatioDs  for  all  objects _ 96 

Total  number  approved  and  allotments  made _ 58 

Total  number  not  approved 38 

Applications  prior  to  Jan.  1,  1920 56 

Allotments  effective  1919-20 38 

Applications  between  Jan.  1  and  June  30,  1920 ' 40 

Allotments  effective  1920-21 20 

Applications,  departments  of  hygiene 74 

Approved 41 

Effective  in  academic  year  1919-20 29 

Effective  in  academic  year  1920-21 ^  12 

Not  approved 38 

Applications,  summer  schools 11 

Approved 10 

Effective  1919 7 

Effective  1920 3 

Disapproved 1 

1  In  addition  to  these  12  new  applications  for  allotments  to  be  effective  in  1920-21, 
27  applications  for  renewals  have  been  granted,  making  a  total  of  39  allotments  efEective 
in  1920-21. 


REPOET  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.     133 

Applications,   researclies 8 

Approved 5 

Effective  1919-20 2 

Effective  1920-21 3 

Not  approved 3 

Applications,  State  divisions  educational  hygiene 3 

Approved ; 2 

Pending 1 

All  for  1920-21. 

3.   allotments:       number,      AMOUNTS,    PURPOSE,      DISTRIBUTION,      AND 

RELEVANT    FACTS. 

(1)  Allotments  effective  in  academic  year  1919-20: 

In  the  report  of  last  year  it  was  shown  that  allotments  aggregat- 
ing $166,090  had  been  made  to  24  institutions.  Of  these  23,  aggregat- 
ing $159,490,  were  for  the  purpose  of  assisting  normal  schools,  col- 
leges, and  universities  to  establish  departments  of  hygiene  in  general 
conformity  with  the  policy  and  plan  set  forth  in  the  rules  and  regula- 
tions ;  one  allotment  of  $6,600  was  made  for  the  purpose  of  carrying 
on  a  special  psychological  research.  The  activities  for  which  these 
allotments  were  made  were  to  be  begun  and  carried  on  in  the  academic 
year  1919-20.  One  of  these  institutions,  later  found  itself  unable  to 
carry  out  the  agreement  and  returned  its  allotment  of  $5,120  thereby 
reducing  the  total  from  $166,090  to  $160,970. 

Subsequent  to  June  30,  1919,  seven  other  allotments,  aggregating 
$59,550  were  made  from  the  educational  reasearch  and  development 
fund,  to  be  effective  in  the  academic  year  1919-20.  Of  these,  six 
aggregating  $33,550  were  for  departments  of  hygiene ;  one  of  $26,000 
was  for  sociological  and  psychological  research.  (This  allotment 
covers  two  series  of  researches  totaling  10  projects.    See  p.  153.) 

In  addition  to  these  amounts,  $1,000  was  paid  to  seven  summer 
schools  for  special  instruction  in  social  hygiene. 

The  total  amount,  therefore,  made  available  for  these  several 
objects  in  the  academic  year  1919-20  was  $221,520.  The  distribution 
is:  For  departments  of  hygiene,  $187,920;  for  sociological  and 
psychological  researches,  $32,600 ;  for  summer  schools,  special  instruc- 
tion in  social  hygiene,  $1,000. 

Of  the  $187,920  for  departments  of  hygiene,  $110,085  was  allotted 
to  12  colleges  and  universities;  $67,885  to  13  normal  schools  and 
teachers  colleges;  $2,550  to  one  medical  school  (Woman's  Medical 
College,  Philadelphia) ,  and  $7,400  to  two  institutions  for  the  colored 
race.  The  aggregate  amount  of  resource  supplied  by  these  28  insti- 
tutions in  support  of  departments  of  hygiene  is  $252,320.35,  or 
$64,430.35  more  than  the  amount  supplied  by  the  Interdepartmental 
Social  Hygiene  Board.    This  figure  is  too  small,  as  one  institution 


134      EEPOET  U.  S.  INTERDEPAETMENTAL  SOCIAL,  HYGIENE  BOARD. 

which  supplied  an  amount  for  its  department  of  hygiene  several  times 
greater  than  that  supplied  by  the  board  has  failed  to  report  this 
amount.  The  ratio  of  local  fund  to  the  fund  supplied  by  the  board 
varies  widely;  from  less  than  one-sixth  the  amount  furnished  by 
the  board  to  more  than  four  times  that  amount.  It  is  to  be  remem- 
bered that  the  board  supplies  funds  in  payment  of  ]3ersonal  service 
only.  The  amounts  reported  as  supplied  by  the  institutions  are 
likewise  for  personal  service.  The  cost  of  equipment,  supplies,  light, 
heat,  janitor  service,  repairs,  replacement,  and  general  administration 
is  not  included. 

The  number  of  students  in  these  28  institutions  that  have  received 
instruction  and  training  in  hygiene  is  reported  as  28,143 — 12,639  men 
and  15,504  women.  These  figures  are  probably  too  low,  as  a  number 
of  the  colleges  and  universities  reported  statistics  only  of  students 
preparing  as  teachers,  whereas  the  report  of  departmental  activities 
shows  clearly  that  the  program  included  large  numbers  of  other 
students. 

The  following  tabular  summary  shows  in  detail  the  important 
items  discussed  m  the  immediately  preceding  paragraphs : 

Tabular  summary  of  allotmefits  effective  for  departments  of  hygiene  in  1919-20 

and  related  facts. 


Number. 

Resource  for  departments  of 
hygiene. 

Number  students 
affected. 

Type  of  institution. 

Interde- 
partmental 
Social 
Hj'giene 
Board. 

Institution. 

Joint. 

Men. 

Wom- 
en. 

Total. 

A.  Colleges  and  universities 

B.  Normal  schools  and  teachers' 

12 

13 
1 
2 

8110,085 

67,885 
2,550 
7,400 

Sl.58,311.00 

89,099.35 

350.00 

4. 560. 00 

$268,396.00 

156,984.35 
2,900.00 
11,960.00 

10,918 

1,486 

'"'2.35' 

5, 502 

9,652 
85 
265 

16,420 
11,138 

85 

D    Colored                   

500 

' 

Total 

28 
2 
7 

187,920 

32,600 

1,000 

252,320.35 

440,240.35 

12,639 

15,504 

28,143 



37 

221,520 

1 

(2)  Allotments  effective  in  academic  year  1920-21 : 
Subsequent  to  January  1,  1920,  and  prior  to  June  30,  1920,  allot- 
ments were  made  from  this  fund  aggregating  $384,826,  to  be  effective 
in  the  academic  year  1920-21.  Of  this  aggregate  $344,101  was 
allotted  to  39  normal  schools,  colleges,  and  universities  for  depart- 
ments of  hygiene ;  $12,900  to  two  State  universities  for  cooperation 
with  State  departments  of  education  in  establishing  divisions  of 
educational  hygiene ;  $5,825  to  three  summer  schools  for  instruction 
and  demonstration  in  social  hygiene ;  and  $22,000  for  three  sociological 
and  psychological  researches. 


REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.      135 

Of  the  $344,101  allotted  to  educational  institutions  for  depart- 
ments of  hygiene,  $239,501  was  paid  to  27  institutions  to  assist  them 
in  continuing  the  work  in  hygiene  undertaken  under  the  grant  of 
the  current  year;  and  $104,600  was  paid  to  12  institutions  to  assist 
them  in  establishing  departments  of  hygiene.  The  institutions  thus 
assisted  include  20  colleges  and  universities,  14  normal  schools  and 
teachers'  colleges,  one  medical  school  (Woman's  Medical  College  of 
Philadelphia),  and  4  normal  schools  and  colleges  for  the  colored 
race  (Fisk  University,  Hampton,  Tuskegee,  and  Maryland  Normal 
and  Industrial  School).  The  aggregate  amount  of  resource  fur- 
nished by  the  39  institutions  in  support  of  these  departments  of 
hygiene  is  $437,330,  or  $93,229  more  than  allotted  from  the  Inter- 
departmental Social  Hygiene  Board.  The  joint  aggregate  is  $781,431. 
Of  these  39  institutions,  18  supply  an  amount  in  excess  of  the  amount 
allotted  by  the  Interdepartmental  Social  Hygiene  Board;  6  supply 
an  equal  amount;  and  15  less. 

The  number  of  students  who  will  be  affected  is  estimated  by  the 
several  institutions  on  the  basis  of  present  enrollment.  The  total  is 
given  as  35,192 — 16,043  men  and  19,149  women.  These  figures  are 
too  low,  as  several  of  the  institutions  reported  only  students  prepar- 
ing as  teachers,  whereas  the  program  submitted  for  approval  evi- 
dently included  all  students  enrolled.  The  actual  number  will  be 
nearer  40,000  than  35,000. 

Tabular  summary  of  allotments  from  educational  research  and  development 
fund  effective  academic  year  1920-21  and  facts  related  thereto. 


Number. 

Resource  for  departments  of 
hygiene. 

Number  students 
affected. 

Type  of  institution. 

Interde- 
partmental 
Social 
Hygiene 
Board. 

Institution. 

Joint. 

Men. 

Wo- 
men. 

Total. 

A.  Colleges  and  universities: 

11 
9 

$128,125 
88,650 

8176,176 
116,625 

S304,301 
205,275 

7,948 
4,954 

4,580 
3,682 

12,528 

New  allotments 

8,636 

Total            

20 

14 

1 

2 
2 

216,775 

99,926 

4,0.50 

7,400 
15,950 

292,801 

118, 459 

350 

5,310 
20, 410 

509, 576 

218,385 

4,400 

12,710 
36,360 

12,902 
1,779 

310 
1,052 

8,262 

9,829 

89 

280 
689 

21,164 

B.  Normal  schools  and  teachers' 
colleEjes: 

11,608 

C.  Medical  schools: 

Renewal 

89 

D.  Colored: 

590 

1,741 

Total 

39 

2 
3 
3 

344, 101 

12,900 

.5,825 

29,500 

437,330 

781,431 

16,043 

19, 149 

35, 192 

E.  Educational  hygiene  State 
departments  of  education .... 

1 

1 

Total  1 

47 

392,326 

* 

^This  total  includes  unexpended  balances  amounting  to  .$15,475.50  in  the  amounts 
paid  to  institutions  for  use  in  the  academic  year  1919-20.  The  actual  amount  paid  to 
institutions  for  use  in  the  academic  year  1920-21  is  $376,850.50. 


136      KBPORT  U.  S.  INTERDEPAETMENTAL,  SOCIAL  HYGIENE  BOARD. 

As  indicated  above  appropriations  have  been  made  to  four  institu- 
tions for  the  education  of  the  colored  race.  It  is  the  policy  of  the 
board  to  extend  this  aid  to  other  institutions  for  the  colored  race  in 
States  with  large  colored  population. 

(3)  Allotments  for  researches  1920-21 : 

As  shown  in  section  2  of  this  report,  appropriations  aggregating 
$29,500  have  been  made  to  three  institutions  for  sociological  and 
psychological  researches  to  be  carried  on  during  the  fiscal  year 
1920-21. 

(a)  An  allotment  of  $2,000  has  been  paid  to  the  Massachusetts 
State  Psychiatric  Institute  for  "An  Investigation  on  the  Family  of 
the  Syphilitic."  This  study  was  begun  last  year  under  a  grant  from 
the  Scientific  Research  Fund.  As  the  study  progressed  the  prob- 
lems involved  were  found  to  be  predominantly  sociological  rather 
than  medical.  The  allotment  for  continuance  of  the  research  is 
made  therefore  from  the  educational  research  and  development  fund. 

(h)  An  allotment  of  $5,000  has  been  made  to  Johns  Hopkins  Uni- 
versity "  for  the  purpose  of  developing  a  laboratory  manual  and 
illustrative  material  to  be  used  in  carrying  out  the  suggestions  made 
in  Part  II  of  the  outline  and  syllabus  on  hygiene  issued  by  the 
board." 

(c)  Two  allotments  of  $5,000  and  $10,000,  respectively,  have  been 
made  to  the  American  Social  Hygiene  Association.  The  allotment 
of  $5,000  is  "  for  the  formation  of  a  competent  committee  to  investi- 
gate, evaluate,  and  report  on  the  educational  and  informational 
values  of  social  hygiene  literature."  The  allotment  of  $10,000  is  for 
the  development  of  three  new  films,  one  for  use  with  policemen,  one 
describing  the  protective  social  measures  program  that  is  being  de- 
veloped by  the  Interdepartmental  Social  Hygiene  Board,  and  one 
to  be  used  in  connection  with  other  public  health  films. 

A  supplementary  allotment  of  $7,500  has  been  made  to  complete 
the  researches  begun  under  the  allotment  for  1919-20  noted  on  page 
130  above  and  described  on  pages  153-154  below. 

(4)  Allotments  to  State  universities  for  cooperation  with  State 
departments  of  education  in  organizing  divisions  of  hygiene  in  State 
departments  of  education : 

In  conformity  with  the  plans  and  regulations  shown  in  that  part 
of  last  year's  report  dealing  with  future  policies,  allotments  aggre- 
gating $12,900  have  been  made  to  two  State  universities  for  coopera- 
tion with  the  State  department  of  education  in  these  States  in  or- 
ganizing divisions  of  educational  hygiene  within  the  said  department. 

The  States  and  institutions  involved  are:  Mississippi,  the  Uni- 
versity of  Mississippi,  $6,400;  Kentucky,  the  University  of  Ken- 
tucky,' $6,500. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     137 

(5)  Allotments  to  summer  schools: 

Ten  allotments  have  been  made  to  summer  schools  for  the  inclu- 
sion of  special  consideration  of  social  hygiene  in  their  programs. 
Seven  of  these  were  made  effective  in  the  summer  of  1919.  The 
total  of  these  allotments  was  $1,000.  Of  the  seven  institutions  thus 
assisted,  four  are  now  cooperating  with  the  board  in  maintaining 
permanent  departments  of  hygiene.  For  the  summer  of  1920  three 
allotments  have  been  made  aggregating  $5,825.  Of  this  amount 
$5,000  was  allotted  to  Teachers  College,  Columbia  University,  to 
enable  that  institution,  in  cooperation  with  the  Interdepartmental 
Social  Hygiene  Board,  the  United  States  Public  Health  Service,  the 
United  States  Bureau  of  Education  and  the  American  Social  Hygiene 
Association,  to  put  on,  during  the  summer  session,  a  complete  pro- 
gram of  social  hygiene  in  its  educational  relations. 

The  policy  of  the  board  with  respect  to  summer  schools  is  to  make 
allotments  hereafter  only  for  clearly  defined  and  specialized  projects. 

4.   ADMINISTRATIVE    RELATIONS   BETWEEN   THE   BOARD   AND    COOPERATING 
DEPARTMENTS  OF  HYGIENE. 

The  principles  by  which  the  Interdepartmental  Social  Hygiene 
Board  would  be  guided  in  its  administrative  relations  with  normal 
schools,  colleges,  and  universities  establishing  departments  of  hygiene 
in  cooperation  Avith  the  board  was  stated  in  the  report  for  1918-19 : 
"  In  proposing  this  organization  the  board  has  not  undertaken  to 
dominate  the  educational  methods  or  text  presentation  in  any  of 
the  educational  institutions  with  which  it  has  come  into  cooperative 
relationship.  It  is  assumed  that  each  of  these  institutions  is  a  high- 
class  educational  organization  that  may  be  depended  upon  to  select 
with  experienced  educational  intelligence  the  methods  of  instruction 
that  are  most  likely  to  fit  the  special  needs  of  its  own  particular 
student  body.  Each  of  these  institutions  may  be  regarded  as  being 
engaged  in  carrying  out  a  research  for  the  discovery  and  demonstra- 
tion of  better  methods  of  education  in  the  prevention  of  diseases." 
This  principle  has  been  scrupulously  observed  in  all  the  dealings  of 
the  board  with  the  40  institutions  that  have  received  allotments  or  ex- 
tended their  departments  of  hygiene  in  conformity  with  the  program 
proposed  by  the  board. 

The  board  is  clear  and  explicit  in  its  convictions  that  instruction 
relative  to  the  venereal  diseases  must  be  integrated — not  submerged — 
in  the  composite  program  of  hygiene,  "  emphasizing  with  appropriate 
and  due  proportion  and  with  proper  tact  and  persistency,  the  serious 
importance  of  the  venereal  diseases,  their  causes,  carriers,  and  preven- 
tion."   It  is  equally  clear  and  explicit  in  its  conviction  that  to  secure 


138      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  H-XGIENE  BOARD. 

largest  results  an  integrated  organization  of  all  the  hygienic  factors 
and  resources  of  the  institution  is  necessary.  To  that  end  it  recom- 
mends an  organization  that  coordinates  and  integrates  in  one  de- 
partment or  service  the  teaching  of  informational  hygiene;  indi- 
vidual health  examination,  consultation  and  conference ;  the  physical 
training  activities;  the  emergency  care  of  students  in  clinic  and 
infirmary ;  the  sanitary  supervision  of  the  various  parts  of  the  insti- 
tution ;  and  the  development  of  a  hygiene  consciousness  in  the  insti- 
tution as  a  whole.  On  the  other  hand  the  board  recognizes  that  in 
many  institutions  the  several  elements  in  this  composite  program 
exist  more  or  less  independent  of  each  other  and  severally  developed 
in  unequal  degree.  These  institutions  vary  widely  in  age,  traditions, 
resources,  specific  purpose,  and  equipment.  There  are  normal  schools 
limited  to  a  two-year  course  and  there  are  universities  with  four-year 
undergraduate  course  and  full  graduate  organization;  there  are 
schools  exclusively  for  preparation  of  elementary  teachers  and  others 
exclusively  for  secondary  teachers ;  there  are  schools  for  the  cultural 
education  of  selected  social  and  intellectual  classes  and  schools  voca- 
tional in  purpose  and  emphasis;  there  are  schools  exclusively  for 
men,  exclusively  for  women,  and  coeducational.  Obviously,  there- 
fore, there  are  wide  variations  in  the  adaptation  of  the  program  out- 
lined by  the  board  to  local  institutional  needs.  Some  have  been  able 
to  approximate  the  entire  program,,  both  in  content  and  organization. 
Others  have  made  only  a  modest  beginning. 

In  its  administrative  relations  with  these  cooperating  institutions 
it  has  been  the  policy  of  the  board  to  encourage  each  of  them  to 
bring  about  equal  efficiency  of  all  the  factors  in  the  departmental  pro- 
gram and  to  realize  as  completely  and  as  rapidly  as  possible  the 
benefits  of  unified  organization.  It  has  not  sought  to  bring  about 
immediate  mechanical  adoption  61  the  plan  of  organization. 

In  general  the  attitude  of  all  the  institutions  has  been  one  of  free 
active  cooperation  in  the  development  of  a  great  educational  enter- 
prise. The  institutions  that  have  been  cooperating  with  the  board 
for  the  past  year,  in  increasing  measure  are  seeking  advice  and  coun- 
sel from  the  board;  and  the  institutions  to  which  new  allotments 
have  been  made  have  been  careful  to  secure  information  and  advice 
in  the  formulation  of  their  plans  of  organization.  This  is  without 
any  sacrifice  of  their  autonomy  of  management  or  independence  of 
judgment;  it  is  merely  in  recognition  of  the  fact  that  the  board  pre- 
sents a  program  that  commands  respect,  and  that,  therefore,  the 
board  should  be  called  upon  for  the  information  and  counsel  that  its 
program  justifies  the  institutions  in  expecting  it  to  furnish  for 
their  guidance. 


KEPORT  U,  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.     139 

5.  ADMINISTRATION   OF  THE   EDUCATIONAL  RESEARCH   AND  DEVELOPMENT 

FUND. 

(1)  Prior  to  January,  1920,  all  of  the  functions  and  duties  in- 
volved in  administering  this  fund  were  performed  by  the  executive 
secretary.  This  situation  was  unsatisfactory  for  three  reasons :  The 
handling  of  this  work  required  a  disproportionate  amount  of  the 
executive  secretary's  time  and  attention ;  the  vital  importance  of  this 
part  of  the  board's  program,  the  increasing  volume  of  the  work  in- 
volved, and  complexity  of  the  problems  showed  clearly  the  need  of 
a  divisional  organization  and  responsibility;  the  constantly  increas- 
ing demand  for  advice  and  assistance  on  the  part  of  cooperating  in- 
stitutions and  ai)plicants  for  assistance  in  planning  their  organiza- 
tions and  programs  emphasized  the  need  of  competent  field  service. 
To  meet  these  needs,  the  most  urgent  of  which  was  the  field  work, 
the  board  through  the  Civil  Service  Commission  appointed,  on  Jan- 
uaiy  1,  1920,  a  superintendent  of  field  service  for  the  educational  re- 
search and  development  fund,  with  the  following  specifications  of 
duties : 

The  duties  of  the  appointee  will  be  to  assist  the  executive  secretary  of  the 
board,  as  follows : 

(a)  Selecting  colleges,  universities,  and  other  suitable  institutions  or  organi- 
zations in  which  to  develop  and  demonstrate  more  effective  educational  meas- 
ures for  the  prevention  of  venereal  diseases. 

(5)  Selecting  colleges,  universities,  and  other  suitable  institutions  or  organi- 
zations for  sociological  and  psychological  research  for  better  methods  of  educa- 
tion and  demonstration  in  the  prevention  of  venereal  diseases. 

(c)  Sifting  and  judging  educational,  sociological,  and  psychological  re- 
searches proposed. 

(d)  Applying  the  rules  and  regulations  of  the  board  as  required  by  law. 

(e)  Determining  proper  sums  to  be  expended  for  educational  development, 
improved  educational  methods,  and  for  sociological  and  psychological  research 
In  the  various  institutions  assisted  by  the  board. 

(f)  Following  up  and  checking  these  investments  of  the  Government  in 
order  to  ascertain  their  usefulness. 

(g)  Organizing  and  publishing  reports  from  educational  institutions  and 
other  organizations  to  which  funds  are  allotted  by  the  board. 

Subsequent  to  this  appointment  it  was  decided  by  the  board  that 
hereafter  no  allotments  would  be  made  from  this  fund  for  depart- 
ments of  hygiene  until  the  applying  institutions  should  have  been 
inspected  and  a  report  made  showing  that  "the  institution  con- 
cerned can  and  will  satisfy  the  terms  of  their  agreement  with  the 
board.  The  executive  secretary  was  further  authorized  to  withhold 
payment  in  full  or  in  part  to  a  given  institution  in  case  he  finds 
upon  investigation  that  such  a  course  is  indicated."    This  "regulation 


140      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOAED. 

covered  both  applications  for  continuance  of  assistance  and  new 
applications. 

(2)  In  fulfillment  of  these  duties  the  superintendent  of  field  service 
of  necessity  has  spent  the  major  part  of  his  time  in  the  field,  inspect- 
ing normal  schools,  colleges,  and  universities.  Visits  were  made  to  all 
of  the  28  institutions  already  operating  departments  of  hygiene  under 
allotments  received  from  the  board  and  to  18  institutions  from  which 
applications  for  assistance  were  under  consideration  by  the  board. 
Inspection  of  the  institutions  with  departments  of  hygiene  in  opera- 
tion has  been  determined  by  the  following  specific  objectives :  to  ascer- 
tain the  extent  to  which  the  agreement  to  establish  departments  of 
hygiene  "  in  general  conformity  with  plans  suggested  by  the  board  ^^ 
has  been  carried  out  and  the  difficulties  in  the  way  of  complete  con- 
formity; to  judge  of  the  prospect  for  permanency  of  the  department 
of  hygiene  either  with  or  without  continued  help  from  the  board,  as 
indicated  by  the  personnel  of  the  department,  the  attitude  of  the  ad- 
ministrative affairs,  and  the  financial  resources  of  the  institution ;  tO' 
secure  evidence  of  positive  achievements  as  shown  in  effectiveness 
or  organization,  content  of  courses  of  instruction  and  training,  in- 
terest of  the  students  and  faculty,  and  improved  facilities;  and  to- 
examine  the  facilities  and  equipment  for  formal  instruction  in  hy- 
giene, for  health  examinations  and  for  physical-training  activities 
relative  to  adequacy  and  appropriateness.  Much  time  was  spent  in 
consultation  with  the  departmental  staff  and  with  administrative 
officers.  They  wanted  fuller  understanding  of  the  policies  and  plans 
of  the  board  and  advice  in  regard  to  matters  of  organization  "  in 
general  conformity  with  the  plans  of  the  board." 

Similarly  the  inspection  of  institution  from  which  new  applica- 
tions were  under  consideration  involved  a  complete  survey  of  the 
general  equipment  and  the  special  facilities  of  the  institutions,  the 
elements  of  the  program  already  supported,  the  financial  resources, 
and  the  attitude  and  outlook  of  the  administrative  officers,  of  the 
faculty  and  of  the  special  group  which  would  be  concerned  in  such  a 
department.  Detailed  written  reports  have  been  made  pf  all  inspec- 
tions. 

6.  PROGRESS  IN  EFFECTI^^  ORGANIZATION  OF  DEPARTMENTS  OF   HYGIENE. 

In  section  3  above  it  was  shown  that  the  policy  of  the  board  is  to 
encourage  cooperating  institutions  "to  bring  about  equal  efficiency 
of  all  the  factors  in  the  departmental  program  and  to  realize  as  com- 
pletely and  rapidly  as  possible  the  benefits  of  unified  organization." 
The  ideal  is  healthy  growth  rather  than  mechanical  creation.  This 
section  attempts  to  summarize  the  conditions  of  organization  existing 
in  the  institutions  at  the  time  aid  was  granted  and  the  practical 


KEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAI^  HYGIENE  BOARD.      141 

results  in  the  direction  of  better  organization  secured  by  one  year 
of  such  aid. 

(1)  In  general,  the  conditions  existing  at  the  time  aid  was  granted 
for  departments  of  hygiene  were  of  three  types. 

(a)  Organization  approximating  in  form  and  scope  that  pro- 
posed by  the  board.  In  only  one  of  the  28  institutions  assisted 
(Harvard)  was  there  an  existing  organization  of  this  type  bearing 
the  proposed  name  "  Department  of  Hygiene."  In  this  case  all  of 
the  functions  specified  in  the  board's  plan  were  included  under  the 
existing  "  Department  of  Hygiene."  These  functions  were  unequally 
developed  and  insufficiently  supported.  In  a  few  institutions  the 
proposed  organization  was  approximated  in  an  existing  "  department 
of  physical  education,"  e.  g.,  Universitj^  of  Utah  and  Colorado  State 
Teachers  College.  None  of  these,  however,  included  all  of  the  func- 
tions proposed  and  all  of  them  were  inadequately  supported. 

(5)  Dual  organization.  The  facilities  for  instruction  and  train- 
ing in  hygiene  specified  in  the  program  of  the  board  were  provided, 
in  skeleton  at  least,  in  two  coordinate  departments  or  services.  Ex- 
amples are  University  of  Pennsylvania,  with  a  department  of  hygiene 
and  a  department  of  physical  education ;  Cornell,  with  a  department 
of  physical  education  and  a  "  Student  Health  Service ;"  Oswego 
Normal  School,  with  department  of  physical  education  and  depart- 
ment of  health  education.  None  of  the  institutions  of  this  type 
within  the  existing  coordinate  departments  included  completely  and 
adequately  all  of  the  functions  specified  in  the  organization  proposed 
by  the  board. 

(c)  Functions  more  widely  distributed.  In  a  number  of  institu- 
tions there  was  little  organization  of  the  hygiene  factors  already 
existing.  The  functions  provided  for  in  the  departmental  organiza- 
tion proposed  by  the  board  were  performed  by  three  or  more  distinct 
and  independent  departments  or  services.  In  the  Michigan  State 
Normal  College,  for  example,  four  departments  were  involved: 
Physical  educational  for  examinations,  physical  training  activities 
and  part  of  instruction  in  hygiene;  natural  science  for  instruction 
in  general  and  individual  hygiene ;  the  college  infirmary  for  "  sick- 
ness service  "  and  for  teaching  of  "  home  nursing  "  course ;  a  faculty 
committee  in  charge  of  general  sanitation  and  the  living  conditions 
of  students.  The  institutions  included  in  this  group  varied  widely 
as  to  the  completeness  with  which  the  functions  of  the  organization 
proposed  by  the  board  were  covered  by  the  separate  departments  and 
service  involved.  They  varied  especially  as  to  the  total  number  of 
these  functions  provided  for ;  the  relative  emphasis  upon  the  several 
functions ;  and  the  extent  to  which  unity  of  purpose  and  action  were 
realized.    In  none  of  them,  however,  were  all  of  the  functions  pro- 


142      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

vided  for ;  and  in  most  of  them  there  were  marked  differences  in  the 
adequacy  of  support  given  to  the  different  functions. 

In  all  of  the  institutions,  however,  there  was  realization  of  in- 
adequacy and  appreciation  of  the  desirability  of  unifying  the  func- 
tions. 

2.  In  large  measure  the  problem  of  organization  was  a  problem 
of  financial  resources.  The  resource  supplied  by  the  board  has  en- 
abled most  of  these  institutions  not  only  to  increase  the  amount  of 
activity,  but  also  take  steps  toward  better  organization.  There  is 
growing  appreciation  of  the  fact  that  "  hygiene "  in  the  board's 
program  of  instruction  and  training  is  a  unity — not  merely  a  collec- 
tion of  activities  more  or  less  related.  As  a  corollary  there  is  a 
growing  recognition  of  the  advantages  of  a  unified  organization. 
This  is  represented  by  a  variety  of  procedures  in  the  direction  of 
unified  organization.  A  number  of  institutions  have  reached  the 
desideratum  of  a  single  unified  department  of  hygiene.  Some  have 
progressed  as  far  as  including  all  the  functions  under  one  directing 
head  with  a  bifurcated  title.  Some  have  created  an  administrative 
committee  to  insure  coordination.  Some  have  merely  established  a 
cooperative  modus  vivendi  of  the  departments  involved.  In  the 
institutions  with  unified  organization  there  has  been  increasing  effi- 
ciency through  increased  personnel.  In  the  institutions  with  dual 
or  multiple  organization  there  has  been  increased  efficiency  through 
the  strengthening  of  the  several  functions  in  the  program  and  the 
development  of  coordination.  There  is  no  case  in  which  some  defi- 
nite steps  have  not  been  taken  in  the  direction  of  unifying  all'the  • 
hygienic  factors  and  resources  of  the  institution.  These  factors  and 
resources,  by  virtue  of  this  strengthening  and  unifying,  are  more 
effective  agencies  for  instruction  and  training  in  hygiene  in  general 
and  for  instruction  relative  to  the  venereal  diseases  in  particular. 

Perhaps  one  of  the  most  significant  gains  is  the  realization  on  the 
part  of  many  of  the  departmental  heads  that,  as  one  of  them  has 
stated  it,  "  educational  hygiene  is  a  big,  highly  specialized  job,  which 
can  not  b^  done  successfully  if  regarded  as  a  potboiler  or  as  a  retreat 
for  the  professionally  lazy  or  incompetent."  This  realization  is 
shared  by  the  administrative  heads  of  institutions  in  increasing 
degree. 

7.  EXTENT  TO  WHICH  THE  PROGRAM   OF  INSTRUCTION  AND  TRAINING  IN 
HYGIENE  HAS  BEEN  PUT  INTO  EFFECT. 

It  was  not  expected  by  the  board  in  making  allotments  for  the 
organization  and  establishment  of  departments  of  hygiene  that  the 
complete  program  of  activities  outlined  by  the  board  would  be 
adopted  mechanically  or  could  be  made  effective  immediately  by 
executive  fiat.    The  former  limitation  was  anticipated  in  the  agree- 


EEPOKT  U.  S.  INTEKDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     143 

ment  pledged  by  the  institutions  accepting  aid  from  the  board  that 
the  "instruction  and  training  in  hj^giene  shall  conform  in  general 
plan  and  requirements  "  to  the  program  outlined  and  suggested  by 
the  board.  The  latter  limitation  is  partly  inherent  in  the  project — 
parts  of  the  program  are  concerned  with  consecutive  processes ;  and 
is  partly  a  matter  of  adaptation — adaptation  of  the  proposed  pro- 
gram to  existing  administrative  conditions. 

In  general,  satisfactory  progress  has  been  made  in  putting  the 
program  into  effective  operation.  The  expected  variations  have  oc- 
curred. The  following  summary  of  conditions  at  the  end  of  the 
first  year  are  based  upon  the  written  reports  of  progress  submitted 
by  the  institutions  supplemented  by  inspections  of  all  these  insti- 
tutions :       • 

(1)  Instruction  in  the  "principles  of  hygiene"  has  been  given  in 
all  of  the  cooperating  institutions.  In  nearly  all  of  these  this  has 
been  a  required  subject  for  all  first-year  students.  In  quantity  and 
character  this  instruction  has  conformed  in  general  plan  and  require- 
ments to  the  suggestions  of  the  board  for  "  general "  and  "  indi- 
vidual "  hygiene.  In  the  few  instances  where  the  first-year  require- 
ment has  not  been  made  effective  the  variation  is  justified  either  by 
temporary  maladjustment  of  the  general  program  of  studies  or  by 
intentional  assignment  of  this  requirement  to  some  other  year. 

Group  and  intergroup  hygiene  quite  naturally  have  been  post- 
poned in  most  cases  until  the  second  year  of  operation.  In  some  cases 
courses  in  educational  hygiene  covering  specifically  the  "school 
hygiene"  aspect  of  group  hygiene  were  already  in  effect,  and  of 
course  have  been  continued.  In  a  very  few  cases,  too,  there  were 
existing  courses  in  public-health  administration,  i.  e.,  intergroup 
hygiene.  In  all  cases  it  is  proposed  next  year  to  incorporate  group 
and  intergroup  hygiene  in  the  curriculum. 

(2)  Principles  of  physical  training.  In  more  than  half  of  the 
cooperating  institutions  instruction  in  the  principles  of  physical 
training  was  included  in  the  program  of  studies  prior  to  receiving 
aid  from  the  board.  In  those  institutions  offering  a  curriculum  for 
the  preparation  of  special  teachers  of  physical  education  the  courses 
on  "  principles "  were  of  course  prescribed  for  these  students.  In 
all  other  cases  these  courses  were  elective.  Reports  show  that  all  but 
three  of  the  28  cooperating  institutions  offered  such  courses  last  jea,v. 
All  of  them  will  offer  such  courses  the  coming  year.  Five  of  the 
normal  schools  and  teachers'  colleges  report  that  a  course  in  the 
principles  of  physical  training  will  be  required  of  all  students  after 
this  year.  The  reports  from  all  the  institutions  indicate  extension 
of  this  requirement  as  rapidly  as  possible  for  all  teachers  in  training. 

(3)  Health  examination.  In  all  the  institutions  provision  has 
been  made  for  competent  health  examination  of  the  students.    In  23 


144      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

institutions  all  the  students  were  given  at  least  one  complete  exami- 
nation. Of  these,  11  report  2  complete  examinations;  the  rest  indi- 
cate that  reexamination  of  individuals  is  made  as  needed  within  the 
year,  or  that  two  examinations  will  be  given  in  subsequent  years. 

Of  the  five  reporting  that  not  all  students  are  examined,  two  re- 
port one  complete  examination  of  all  freshmen  and  all  students  in 
teacher  training  and  two  report  examination  of  freshmen  only.  All 
of  these  indicate  reexamination  of  individuals  as  necessar3^  The 
other  reports  "  examinations  as  required." 

There  is  difference  of  opinion  as  to  the  optimum  frequency  of  com- 
plete examinations.  The  majority  opinion  favors  a  minimum  of  one 
complete  examination  each  year,  with  such  reexamination  of  indi- 
viduals as  may  be  indicated  by  the  complete  examination,  by  subse- 
quent illness,  accident,  or  suspicious  symptoms,  by  deterioration  in 
studies,  and  for  participation  in  specialized  athletics.  A  semiannual 
examination  is  regarded  as  desirable  but  not  necessary  if  examina- 
tions are  made  scrupulously  as  indicated  above,  and  if  adequate 
supervision  is  exercised. 

(4)  Sanitary.  Practically  all  report  sanitary  supervision  either 
under  control  of  department  or  in  cooperation  with  other  agencies 
in  the  institution.  This  varies  from  complete  supervision  of  all  the 
hygienic  factors  in  the  institutional  environment  to  rather  casual 
supervision  of  some  of  these  factors.  In  general  there  is  evidence  of 
growing  appreciation  of  the  unitary  character  of  this  function. 

(5)  Conferences  and  consultations.  All  of  the  cooperating  insti- 
tutions report  provision  of  facilities  for  health  conferences  and  con- 
sultations in  fairly  close  conformity  with  the  plans  recommended  by 
the  board.  In  most  cases  accommodations,  time,  and  personnel  are 
adequate.  In  a  few  instances,  especially  where  this  service  is  an 
innovation,  the  technique  of  procedure  is  somewhat  crude;  and  in 
a  few  instances,  more  and  better  space  is  needed.  The  reports  show 
that  in  all  such  cases  the  deficiences  are  appreciated  by  institutions 
and  that  improvements  will  be  made. 

(6)  Physical  training.  The  proposed  program  for  physical  train- 
ing provides  that  each  student  shall  engage  for  one  hour  each  day  in 
some  form  of  physical  exercise  appropriate  to  the  individual  and 
wisely  directed ;  that  this  shall  include  special  training  and  corrective 
exercises  for  all  students  not  organically  fit  for  mass  exercises ;  that 
the  repertory  of  exercises  shall  include  all  appropriate  recreational 
activities  and  may  include  approved  work  activities;  and  that  both 
intramural  and  interinstitutional  athletics  be  included  under  the 
departmental  jurisdiction. 

This  program  for  physical  training  has  met  with  appreciative 
response  from  all  the  cooperating  institutions,  but  few  of  them  have 
been  able  to  put  it  into  full  and  complete  effect.    The  chief  obstacles 


KBPORT  U.  S,  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      145 

are:  Existing  schedules  that  could  not  be  greatly  changed  without 
careful  readjustment;  insufficiency  of  equipment;  insufficiency  of 
personnel,  even  with  the  increase  made  possible  by  the  aid  of  the 
board,  to  take  care  of  all  students  one  hour  daily ;  military-training 
requirements ;  and,  in  case  of  athletics,  the  existence  of  long-standing 
administrative  agencies  for  interinstitutional  athletics.  Progress, 
however,  has  been  made  in  all  institutions  in  overcoming  these  ob- 
stacles and  toward  realization  of  the  program  suggested  by  the 
board. 

(a)  Practically  all  of  the  two-year  normal  schools  have  put  into 
effect  the  qne  hour  a  day  requirement  for  all  students  or  will  do  so 
next  year.    Most  of  them  provide  reconstructional  facilities. 

(h)  The  four-year  institutions  for  the  most  part  have  required 
physical  training  only  in  the  first  two  years.  The  time  requirement 
has  varied  from  two  to  five  hours  per  week.  In  a  few  instances  the 
requirement  is  prescribed  for  freshmen  only.  In  three  of  the  uni- 
versities military  training  is  required  of  freshmen  and  sophomores, 
and  physical  training  is  supplementary.  The  facilities  for  recon- 
structional work  are  reasonably  good  in  most  of  the  institutions. 
In  one  institution  the  almost  complete  lack  of  gymnasium  facilities 
is  a  serious  handicap  both  for  general  and  special  work  in  physical 
training. 

(c)  In  practically  all  of  the  institutions  where  the  prescribed 
physical  training  is  less  than  suggested  by  the  board,  earnest  and 
successful  efforts  have  been  made  to  increase  voluntary  participation, 
both  by  lower  classmen,  whose  prescribed  amount  is  less  than  one 
hour  daily,  and  by  upper  classmen,  for  whom  physical  training  is 
wholly  optional.  Several  report  a  large  part  of  the  students  as  par- 
ticipating. The  percentage  varies ;  it  is  estimated  as  high  as  80  per 
cent  in  one  institution. 

(d)  The  need  of  increased  equipment  and  facilities  has  been  em- 
phasized in  every  institution  where  they  are  inadequate.  Additional 
equipment  has  been  secured  in  several  institutions.  In  some  cases  a 
new  gymnasium  has  been  put  at  the  head  of  the  building  program. 

(e)  In  the  normal  schools  and  teachers'  colleges  the  question  of 
athletic  administration  cuts  no  figure.  In  the  colleges  and  universi- 
ties, however,  the  problem  is  still  vital.  In  all  the  cooperating  col- 
leges and  universities  the  intramural  athletics  are  under  the  direction 
of  the  physical  training  service.  Several  of  these  report  inter- 
collegiate athletics  also  as  so  controlled.  In  the  institutions  where 
the  intercollegiate  athletics  are  under  other  control  there  is  reported 
progress  toward  better  cooperation  between  the  department  of  phys- 
ical training  and  the  athletic  administration.  One  institution  (Cor- 
nell) reports  that  by  "  combining  with  the  athletic  association  on  the 

15610—20 10 


146      REPORT  XJ.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

salary  of  a  number  of  coach-instructors  it  has  been  possible  to  secure 
a  group  of  very  capable  instructors.  This  arrangement  tends  to 
bring  together  all  of  the  physical  work,  puts  it  in  the  hands  of  men 
who  have  been  selected  on  additional  grounds  than  merely  that  of 
coaching  ability,  and  at  the  same  time  permits  of  proper  regulation 
and  supervision.  The  same  procedure  may  in  time  be  followed  in 
the  major  sports." 

(Y)  Kecords  and  planning.  The  division  of  records  and  planning 
as  provided  for  in  the  departmental  organization  proposed  by  the 
board  does  not  imply  special  personnel  or  additional  expense.  The 
object  of  this  provision  is  to  emphasize  the  importance  ,of  keeping 
careful  records  of  activities,  not  primarily  to  be  filed,  but  rather  to 
be  studied  and  used  for  improvement  of  procedures ;  and  the  impor- 
tance of  active  investigation  of  problems  incident  to  the  activities 
of  the  department.  The  value  of  this  function  has  been  generally 
recognized  by  the  cooperating  institutions.  There  is  wide  varia- 
tion, necessarily,  in  the  extent  to  which  the  different  institutions  have 
made  this  division  effective.  All  of  them  have  made  provision  for 
recording  the  medical  examinations.  The  strongest  departments 
report  a  fairly  complete  development  of  this  division,  including 
comprehensive  records  of  examinations  and  consultations  and  of 
subsequent  data  in  regard  to  illness,  defects,  days  lost,  academic 
failures,  etc.;  complete  records  of  optional  recreational  activities; 
records  of  sanitary  inspections ;  definite  investigations  in  progress  or 
proposed.  The  investigations  include  both  technical  problems  and 
immediate  practical  problems,  such  as  better  coordination  of  func- 
tions, regulation  of  living  conditions  of  students,  results  of  the  in- 
creased attention  to  hygiene,  especially  of  the  venereal  diseases,  and 
numerous  others  equally  practical. 

The  significant  thing  is  that  practically  every  institution  reports 
improvement  in  its  record  forms;  a  large  number  report  that  this 
year,  for  the  first  time,  they  have  been  able  to  organize  their  record 
material  for  study  and  comparison;  and  again  practically  all  state 
that  this  phase  of  the  departmental  work  will  be  more  effectively 
developed  next  year, 

(8)  Special  public  health  lectures.  Two-thirds  of  the  cooperating 
institutions  report  that  special  lectures  have  been  secured  from  out- 
side the  institution.  The  number  of  such  special  lectures  varies  from 
three  to  fifteen.  In  some  cases  merely  isolated  lectures  were  given ; 
in  other  cases,  courses  of  lectures  covering  in  detail  some  aspect  of 
hygiene.  The  major  part  of  these  special  lectures  was  concerned 
with  the  venereal  diseases,  but  other  topics  received  occasional  atten- 
tion. In  most  cases  the  special  lectures  were  prepared  for  by  instruc- 
tion through  the  regular  channels  in  the  topics  covered  by  the  lec- 
tures.   The  special  lecture  or  lectures  served  to  clinch  the  instruction. 


KEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     147 
8.    PROGRESS  IN  DEVELOPING  BETTER  EDUCATIONAL  METHODS. 

Sections  4  and  5,  immediately  preceding,  summarize  the  progress 
that  has  been  made  in  the  first  year  in  setting  up  departments  of 
hygiene  and  in  carrying  out  the  general  program  for  instruction  and 
training  in  hygiene. 

In  this  section  a  summary  is  attempted  of  the  progress  that  has 
been  made  in  developing  effective  educational  measures  in  the  pro- 
motion of  hygiene  in  general  and  of  the  hygiene  of  the  venereal 
diseases  in  particular.  Inasmuch  as  it  is  explicitly  purposed  that  in- 
struction in  the  venereal  diseases  is  to  be  integrated  in  the  various 
instructional  and  training  activities  of  the  program  of  hygiene  it  is 
unnecessary,  as  well  as  impracticable,  to  attempt  complete  isolation 
in  this  summary  of  results. 

The  following  conclusions,  which  are  stated  in  general  terms,  are 
based  upon  the  written  annual  reports  supplemented  by  inspection. 
They  represent  the  more  significant  and  better  defined  results. 

(1)  A  tremendous  impetus  has  been  given  to  hygiene  in  the  co- 
operating institutions.  This  is  emphasized  in  nearly  every  report. 
The  following  typical  statements  from  the  Michigan  State  Normal 
College  and  the  North  Dakota  Normal  School,  respectively,  bring 
this  point  out  very  clearly: 

The  very  fact  that  the  teaching  of  hygiene  has  received  Federal  aid  has  increased 
the  interest  of  the  faculty  hi  the  subject  and  has  also  heightened  its  importance 
in  the  minds  of  the  teachers  and  students.  Although  health  work  in  this 
institution  has  always  been  strong  it  is  not  too  much  to  say  that  during  the 
past  year  the  general  interest  in  the  subject  has  been  greatly  intensified. 

Increased  time  and  attention  have  been  given  to  the  teaching  of  hygiene  in 
the  various  curricula  of  the  school.  This  subject  has  been  planned  on  a 
sounder  basis  with  a  place  and  standing  in  our  school  program.  Hygiene  is 
now  on  our  school  map,  and  growing  in  prestige  among  both  the  students  and 
the  faculty. 

(2)  Practically  all  institutions  report  better  health  conditions  and 
increasing  respect  for  hygiene  as  among  the  specific  results.  An 
illustration  of  this  aspect  of  progress  is  the  following  summary  of 
results  reported  by  the  New  York  State  Teachers  College: 

The  net  result  of  the  year's  work  has  been:  («)  To  improve  materially  the 
health,  both  mental  and  physical,  of  a  goodly  number  of  students;  (&)  to 
stimulate  an  intelligent  interest  in  health  knowledge;  (c)  to  convince  a  large 
number  of  them  that  systematic  exercise  is  a  sine  qua  non  of  good  health; 
(d)  to  establish  among  them,  or  at  least'' to  have  made  beginnings  toward  the 
establishment  of,  an  honest,  wholesome  attitude  toward  the  question  of  sex 
and  an  intelligent  appreciation  of  the  venereal-disease  problem. 

The  following  from  the  Cornell  report  emphasizes  the  ultimate 
social  benefits  of  the  program : 

The  human  quality,  the  educational  background,  and  the  social  and  economic 
standards  of  a  body  of  college  students  are  such  that  we  have  a  right  to  expect 


148      REPORT  U,  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

that  they  will  apply  for  tliemselves  and  as  a  service  for  others  the  information 
they  have  acquired.  It  is  fair  to  state  that  the  instruction  has  developed  such 
open-uiindedness  on  subjects  of  health  and  its  protection  that  these  students 
will  not  easily  be  led  astray  by  quackery  and  charlatanism.  They  have  acquired 
some  of  the  critical  sense  and  curiosity  about  self -protection  which  will  serve 
to  make  them  effective  in  support  and  advancement  of  the  public  health  in 
their  communities  where  they  are  certain  to  be  among  the  leaders  in  industry 
and  the  professions. 

(3)  All  of  the  cooperating  institutions  have  given  serious  atten- 
tion to  the  problem  of  integrating  instruction  in  the  venereal  diseases 
in  the  general  program  of  instruction  and  training  in  hygiene.  This 
is  shown  not  only  in  the  formal  reports,  but  also  in  the  frequent 
requests  for  information  and  advice  and  in  the  appreciative  use 
made  of  the  "  Syllabus  on  hygiene "  published  by  the  board.  In 
general  there  has  been  intelligent  appreciation  of  the  opportunities 
offered  by  the  several  factors  in  the  composite  program  of  hygiene 
for  introducing  instruction  in  the  venereal  diseases  and  for  un- 
obstrusively  exerting  wholesome  influence  upon  the  student.  Nearly 
every  report  shows,  not  merely  by  general  statement  but  by  specific 
examples,  that  the  different  factors  in  the  program  have  been  utilized 
and  that  the  importance  of  this  varied  approach  is  recognized.  The 
following  concise  statement  from  the  Winona  Normal  School  is 
typical : 

To  summarize,  then,  every  available  opportunity — ^by  lecture,  by  the  regular 
teaching  force,  in  the  women's  and  in  the  men's  activities,  at  the  time  of  the 
physical  and  medical  examinations,  and  in  the  individual  and  group  conferences — 
has  been  utilized  in  emphasizing  the  hygiene  of  the  venereal  diseases. 

The  New  York  State  Teachers'  College  submits  the  following 
summary  of  factors  employed  to  emphasize  the  hygiene  of  venereal 
disease : 

(a)  Frequent  but  logical  references  to  the  venereal  diseases  in  course  of  dis- 
cussions of  disease  transmission,  heredity,  immunity,  etc.;  (6)  formal  in- 
struction in  hygiene  concerning  sex  and  venereal  disease  prevention;  (c) 
individual  conferences  with  students  on  sex  problems  (at  student's  request)  ; 
(d)  use  of  Government  pamphlets  and  those  from  American  Social  Hygiene 
Association  on  venereal  diseasb  prevention;  (e)  discussions  with  advanced 
students  on  methods  of  presenting  sex  to  high-school  students;  if)  use  of  New 
York  State  Board  of  Health  venereal  disease  prevention  exhibit. 

It  is  the  Consensus  of  opinion  of  the  directors  in  the  cooperating 
institutions  that  the  special  lectures  are  valuable  only  as  they  are 
closely  coordinated  with  the  regular  program  of  instruction;  and 
further  that  the  lecturers  must  be  of  more  than  ordinary  ability. 
Most  of  them  are  planning,  therefore,  to  make  the  special  lectures 
fit  systematically  into  the  regular  course  and  to  exercise  discrimina- 
tion in  the  selection  of  lecturers. 

(4)  There  is  practical  unanimity  of  judgment  that  the  most  ef- 
fective and  most  valuable  instruction  is  that  which  is  given  inci- 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     149 

dentally  in  connection  with  the  individual  health  examination,  con- 
ferences, and  consultations.  The  other  opportunities  in  the  informa- 
tional courses  and  in  connection  with  the  conduct  of  physical-train- 
ing activities  are  not  disparaged  or  ignored.  In  a  number  of  reports 
the  interrelations  of  the  several  factors  are  clearly  shown,  as  in  the 
following  quotation  from  the  Harvard  report : 

The  number  of  health  conferences  has  been  greatly  increased  this  j'ear  due 
to  the  facts  :  First,  the  program  of  required  lectures  to  the  entire  freshmen  class, 
which  has  stimulated  the  desire  to  seek  an  opportunity  for  conferences ;  and 
second,  the  careful  supervision  of  physical  training  by  competent  instructors. 
These  instructors  haA'e  kept  in  close  touch  with  the  students  and  have  not  in- 
frequently advised  them  to  come  voluntarily  for  health  conferences.  Of  course, 
conferences  are  required  of  all  freshmen,  but  in  my  opinion,  more  good  is 
achieved  from  the  voluntarily  sought  conferences  than  from  the  routine  re- 
quired conferences. 

But  the  vital  importance  of  the  examination-conference  oppor- 
tunity is  emphasized  in  nearly  every  report.  This  conviction  is 
clearly  set  forth  in  the  following  excerpts  from  Cornell  and  Harvard 
reports,  respectively: 

The  most  important  work  of  this  department  has  been  the  medical  examina- 
tion of  and  personal  conference  with  each  student  of  the  university  twice  dur- 
ing the  acg.demic  year  by  graduate  physicians  trained  in  the  best  methods  of 
clinical  examination  and  familiar  with  the  dominant  value  of  hygiene  and 
observance  of  the  laws  of  right  living  in  the  prevention  of  disease  and  for  the 
acquisition  and  development  of  vigor  and  positive  health.  It  is  believed  that 
the  privacy  and  intimacy  of  the  sympathetic  discussion  and  analysis  of  personal 
habits  and  conduct  of  life  afforded  to  and  availed  of  by  the  students  gives 
more  tangible  and  permanent  results  than  any  other  method  of  approach  in 
this  subject.  In  addition  to  the  detection  and  removal  of  physical  and  functional 
defects,  there  has  been  a  very  general  overhauling  and  readjustment  of  the 
habits  and  manner  of  living  of  many  students  as  a  result  of  these  conferences 
with  the  medical  advisory  staff.     (Cornell.) 

Instruction  by  lecture  is  not  sufficient  for  the  complicated  subject  of  social 
hygiene. 

In  our  experience,  the  facts  as  given  in  the  lecture  are  regarded  as  having 
general  application  but  not  special  application  to  one's  own  case.  Many 
physicians  preach  the  gospel  of  hygiene  and  then  neglect  il  in  every  possible 
manner  themselves.  Students  are  apt  to  take  such  a  theoretical  and  distant 
attitude  in  regard  to  lecture  instruction.  The  problem  must  be  brought  home 
in  a  very  definite  and  personal  way,  and  a  favorable  oDportunitv  is;  furnished 
at  the  time  of  the  physical  examination.  *  *  *  It  is  not  possible  at  the 
time  of  the  physical  examination  to  give  detailed  and  extensive  instruction 
in  social  hygiene.  It  is  possible,  however,  to  break  down  the  ban-iers  of  em- 
barrassment, and,  after  breaking  them  down  and  starting  discussion,  to  make 
appointment  with  the  student  for  proper  follow-up  advice — and  that  is  the  active 
function  of  such  physical  examination.     (Harvard.) 

This  realization  of  the  supreme  importance  of  the  health  exami- 
nation as  an  instrument  for  instruction  and  guidance  is  a  significant 
step  in  developing  more  effective  educational  measures. 


150      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

(5)  There  is  a  growing  conviction  that  separate  provision  must  be 
made  for  the  two  sexes  in  the  courses  in  informational  hygiene, 
especially  in  individual  hygiene.  This  is  clearly  expressed  in  the 
following  statement  from  the  New  York  State  Teachers  College: 
"  From  our  experience  *  *  *  all  of  the  advantages  are  on  the 
side  of  separate  instruction  in  individual  hygiene.  In  group  and 
intergroup  work  it  is  immaterial.  The  reason  for  this  is  not  because 
of  embarrassment  on  the  part  of  either  student  or  instructor,  but  be- 
cause there  is  a  distinctly  specialized  distribution  of  emphasis  re- 
quired in  handling  the  subject  matter  for  the  two  sexes."  Numerous 
illustrative  examples,  not  quoted  here,  show  clearly  that  the  difference 
oi  emphasis  relates  to  other  aspects  of  personal  hygiene  than  sex  con- 
siderations. It  is  uneconomical  therefore  to  attempt  to  teach  indi- 
vidual hygiene  in  mixed  classes.  Most  of  the  directors,  when  they 
began  this  work  a  year  ago,  were  not  clear  upon  this  point.  It  is  a 
distinct  contribution  to  the  "  development  of  more  effective  educa- 
tional measures"  that  a  number  of  the  strongest  departments  of 
hygiene  cooperating  with  the  board  have  reached  this  definite 
conclusion. 

9.    INDIRECT  INFLUENCE  THROUGH  DEPARTMENTS  OF  HYGIENE. 

The  direct  influence  of  departments  of  hygiene  is  exerted  upon  the 
institution  of  which  they  are  parts ;  upon  practices,  habits,  ideals,  and 
attitudes  of  the  individual  students ;  upon  the  individual  attitudes  of 
the  teachers ;  upon  the  collective  attitude  of  faculties  and  administra- 
tive officers  as  expressed  in  administrative  policies ;  upon  the  effective- 
ness of  sanitary  regulations  and  practices  within  the  institutions. 
These  influences  are  capable  of  approximate  measurement  and  evalu- 
ation. Such  measurement  and  evaluation  is  the  function  of  the  Divi- 
sion of  Records  and  Planning  provided  for  in  the  departmental  or- 
ganization. The  indirect  influences  are  not  so  readily  definable  and 
not  so  susceptible  of  demonstration ;  they  are  not  the  less  real  and 
important.  There  are,  however,  three  ways  in  which  such  influence 
may  be  exerted  (and  generally  is  exerted.) 

Obviously  it  is  too  early  to  secure  much  evidence  as  to  these  lines 
of  indirect  influence.  One  year  is  hardly  sufficient  to  generate  the 
radiating  force.  It  is  interesting  to  note,  however,  that  many  of  our 
cooperating  institutions  are  very  much  alive  as  to  this  problem. 
They  are  preparing  not  only  to  make  their  influence  felt  in  these 
three  ways,  but  also  to  follow  up  and  estimate  the  strength  and 
effectiveness  of  these  lines  of  influence. 

(1)  Influence  by  example : 

One  indication  of  this  type  of  influence  is  the  number  of  applica- 
tions and  inquiries  that  come  from  institutions  that  have  heard  di- 
rectly about  the  program  from  cooperating  institutions. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     151 

Another  example  of  this  type  of  influence  is  shown  in  the  follow- 
ing quotation  from  the  Harvard  report : 

A  most  important  feature  of  the  work  and  one  which  can  not  be  overempha- 
sized is  the  relation  of  this  particular  program  at  Harvard  to  other  communities. 
Already  following  the  lead  of  Harvard  certain  large  preparatory  schools  have 
adopted  a  program  in  hygiene  suitable  to  their  peculiar  needs.  A  great  deal 
of  time  has  been  spent  in  explaining  this  program  by  various  members  of  the 
staff  to  interested  groups  of  people,  who  include  not  only  doctors  in  the  sense 
of  individuals  connected  with  colleges  and  secondary  schools  but  also  indi- 
viduals interested  in  the  general  problems  of  health  of  industries  and  com- 
munities. The  Harvard  program  has  raised  a  great  deal  of  interest  as  an 
experiment.  It  has  been  extremely  successful,  and  consequently  the  influence 
of  this  successful  experiment  will  undoubtedly  be  far-reaching. 

(2)  Influence  through  graduates  as  teachers: 

Obviously  even  less  evidence  of  this  type  of  influence  could  be 
gathered  in  one  year  than  of  the  preceding.  There  must  be  a  suffi- 
cient lapse  of  time  so  that  the  records  of  several  succeeding  graduat- 
ing classes  may  be  studied.  A  number  of  the  cooperating  normal 
schools  are  including  in  the  program  of  the  division  of  records  and 
planning  definite  plans  for  securing  information  from  their  gradu- 
ates in  regard  to  their  accomplishments  for  hygiene  in  the  schools 
and  communities  they  serve.  These  plans  contemplate  not  sensa- 
tional and  sporadic  efforts,  but  systematic  efforts  to  follow  up  the 
work  of  teachers  who  have  had  the  benefits,  during  their  period  of 
training,  of  this  program  of  hygiene. 

(3)  Influence  through  extension  divisions : 

A  good  many  of  the  cooperating  institutions  have  well  organized 
extension  departments.  In  some  of  these  institutions  effective  co- 
operation has  been  established  between  the  two  departments.  In 
general  the  function  of  the  department  of  hygiene  has  been  to  fur- 
nish the  extension  department  with  material,  to  aid  in  securing  such 
material,  and  to  advise  as  to  its  use.  In  a  few  instances,  where  ex- 
tension departments  do  not  exist  a  beginning  has  been  made  toward 
some  extension  work  by  the  department  of  hygiene. 

Of  the  former  class,  the  University  of  Utah  is  a  good  illustration. 
Through  its  extension  division  the  following  classes  of  organizations 
were  reached  by  lectures :  Boy  Scouts,  Camp  Fire  Girls,  mutual  im- 
provement societies,  relief  societies,  Sunday  schools,  parent-teachers' 
associations.  The  University  of  Mississippi  illustrates  the  second 
class.  It  has  undertaken  to  organize  and  distribute  carefully  se- 
lected "package  libraries"  to  organizations  upon  request.  If  the 
plan  matures,  such  package  libraries  will  be  furnished  to  school  au- 
thorities, teachers,  parent-teachers'  organizations,  boys'  and  girls' 
clubs,  health  officers,  women's  clubs,  physicians,  and  newspapers. 


152      REPOET  U.  S.  INTEEDEPARTMENTAL.  SOCIAL  HYGIENE  BOAED. 

10.  researches:  sociological  and  psychological. 

Under  the  authority  reposed  in  the  board  lo  allot  money  from  the 
educational  research  and  development  fund  to  qualified  institutions 
"  for  the  purpose  of  making  sociological  and  psychological  researches  " 
related  to  "more  effective  educational  measures  in  the  prevention 
of  venereal  diseases,"  two  allotments  were  made  for  researches  to 
be  carried  on  during  the  fiscal  year  1919-20.  The  character  of  these 
researches  and  the  progress  made  in  carrying  them  on  are  sum- 
marized below. 

1.  Psychological  laboratory,  Johns  Hopkins  University: 

(1)  Under  date  of  June  6,  1919,  an  allotment  of  $6,600  was  made 
to  the  psychological  laboratory  of  the  Johns  Hopkins  University  for 
the  "  purpose  of  investigating  the  informational  and  educative  eifect 
upon  the  public  of  certain  motion-picture  films  used  in  various 
campaigns  for  the  control,  repression,  and  elimination  of  venereal 
diseases."  This  investigation  was  undertaken  by  Dr.  John  B.  Wat- 
son, assisted  by  Dr.  K.  S.  Lashley,  under  the  general  supervision  of 
an  advisory  committee,  approved  by  the  Interdepartmental  Social 
Hygiene  Board.  This  committee  consisted  of  Dr.  Adolf  Meyer, 
director  of  the  Phipps  Psychiatric  Clinic,  Baltimore,  Md. ;  Dr.  S.  I. 
Franz,  psychiatrist.  Government  Hospital  for  the  Insane,  Washing- 
ton, D.  C. ;  and  Dr.  Robert  S.  Woodworth,  professor  of  psychology, 
Columbia  University,  New  York. 

The  research  was  formulated  and  conducted  with  the  specific  object 
of  securing  data  that  would  aid  materially  and  reliably  in  answering 
four  questions  relative  to  the  informational  and  educative  effects  of 
the  pictures  already  in  use : 

(a)  The  amount,  kind,  and  accuracy  of  information  they  can  give; 

(&)   The  emotions  they  arouse; 

(c)  The  transitory  and  permanent  effects  they  produce  in  the  behavior  of 
those  who  see  them ; 

(d)  The  probable  social  effects  of  such  permanent  modifications  in  behavior 
as  may  be  made. 

The  method  of  procedure  included:  A  preliminary  study  of  all 
films  now  in  use  for  the  purpose  of  selecting  the  film  best  adapted 
to  the  objects  of  the  research;  thorough  analysis  of  the  film  selected 
("Fit  to  Win"),  with  respect  to  its  informational  and  emotional 
content  and  the  relative  distribution  of  time  and  emphasis  to  the 
different  informational  and  emotional  effects  aimed  at;  showing  of 
the  film  to  many  groups  of  individuals  of  various  economic,  social, 
and  educational  status,  and  investigation  of  the  results  of  such  show- 
ings by  questionnaires,  personal  conferences,  observation  of  audiences, 
and  inquiries  as  to  results  in  communities  after  a  lapse  of  some 
months. 


KEPOET  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     153 

This  main  line  of  investigation  was  supplemented  by  an  elaborate 
set  of  questions  designed  to  "  obtain,  from  medical  men  and  women 
who  have  had  most  to  do  with  problems  in  sex  -education  and  the 
actual  treatment  of  venereal  infections,  judgments  and  opinions  as 
to  what  it  is  Avise  and  safe  to  present  to  the  public." 

(2)  The  status  of  this  investigation  up  to  June  30,  inclusive,  is 
reported  by  Dr.  Watson  as  follows: 

(a)  A  fairly  elaborate  qiiestiouary  dealing  with  sex  education,  with  facts 
that  will  as.siist  us  in  evaluating  the  iilni,  "Fit  to  Win,"  and  with  tliose  relevant 
to  the  construction  of  future  films  for  venereal-disease  propaganda,  was  sent  to  all 
members  of  the  American  Psychopathological  Association,  American  Gynecologi- 
cal Society,  and  The  American  Association  of  Genito-Urinary  Surgeons.  The  re- 
sponse to  this  questionary  was  very  generous  indeed  and  so  far  as  I  know  it  is 
the  first  serious  attempt  to  gain  a  consensus  of  o-pinion  of  medical  men  on  such 
problems.  This  material  has  been  copied  in  its  entirety  and  copies  will  be  de- 
posited with  the  United  States  Interdepartmental  Social  Hygiene  Board, 
American  Social  Hygiene  Association,  national  committee  for  mental  hygiene, 
Phipps  Psychiatric  Clinic.  Most  venereal  disease  propaganda  are  the  concep- 
tions and  executions  of  a  single  individual  or  at  most  .a  small  group  of  in- 
dividuals. This  body  of  medical  opinion  should  be  consulted  by  every  one 
engaged  in  venereal  disease  insti'uction.  The  complete  document  is  so  long  that' 
a  summary,  which  will  represent  about  50  printed  pages,  is  being  prepared  for 
the  journal.   Mental   Hygiene. 

(&)  The  film  has  been  shown  to  many  groups  of  individuals.  We  may 
mention  briefly,  at  Camp  Plolabird  to  1,000  soldiers ;  at  Wilmington  to  a  body 
of  Du  Pont  individuals,  including  superintendents,  assistant  superintendents, 
and  personnel  workers ;  before  500  individuals  of  the  Brooklyn  Rapid  Transit 
Co.  (the  audience  in  this  case  was  confined  solely  to  motormen,  conductors,  and 
car-barn  workers)  ;  before  500  sailors  at  the  Seamen's  Institute,  New  York. 
In  all  of  these  showings,  many  details  bearing  upon  the  present  film  and  all 
future  films  were  observed.  Furthermore,  in  all  of  these  cases  the  questionary 
was  filled  out  by  the  audience.  On  the  basis  of  these  results  it  is  possible  for  us 
to  obtain  a  good  idea  of  the  organization  of  the  audience  concerning  venereal- 
disease  matters  before  the  film  was  shown,  and  their  increased  organiza1;ion 
due  to  the  showing  of  the  film.  The  actual  film  showings  and  the  filling  out 
of  the  questionary  together  with  our  own  observations  on  the  effect  of  the 
film  will  represent  the  bulk  of  the  report  we  are  now  preparing. 

(c)  In  addition  to  this  work  where  results  can  be  controlled,  we  selected  two 
towns  in  Maryland,  Salisbury  and  Cambridge,  for  active  propaganda  work. 
These  towns  were  circularized,  posters  were  put  up,  newspaper  notices  were  in- 
serted, etc.,  and  the  films  were  shown  for  a  whole  week  to  both  negi'oes  and 
whites.  Previous  to  our  showing  the  films  in  these  towns  we  had  gained  con- 
fidence of  the  physicians,  druggists,  and  clergymen.  Valuable  material  is  col- 
lecting as  a  result  of  this  work.  It  is  collecting,  of  course,  in  the  form  of 
opinions  and  judgments  gathered  by  the  physicians,  druggists,  and  clergymen 
from  the  conversation  and  actions  of  the  citizens  who  saw  the  film. 

(d)  The  complete  report  should  be  in  the  hands  of  the  United  States  Inter- 
departmental Social  Hygiene  Board  on  or  about  September  1.  This  will  be 
printed  in  full,  but  in  what  journal  is  not  yet  determined. 


154      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

2.  American  Social  Hygiene  Association : 

Allotment  was  made  July  25, 1919,  to  the  American  Social  Hygiene 
Association  for  two  series  of  practical  investigations.  For  the  prepa- 
ration of  a  series  of  motion-picture  films,  $15,000  was  allotted;  and 
for  study  and  preparation  of  new  literature,  $11,000.  Progress  in 
these  two  projects  is  set  forth  in  the  report  by  the  general  director  of 
the  American  Social  Hygiene  Association,  June  30, 1920,  as  follows : 

During  the  past  fiscal  year  the  American  Social  Hygiene  Association  has 
been  engaged  upon  a  series  of  enterprises  involving  educational  research  in  the 
development  of  motion-picture  films  and  new  literature. 

(1)  Motion-picture  films: 

First,  the  film  for  the  education  of  the  physicians  in  the  modern  diagnosis  and 
treatment  of  gonorrhea  has  been  completed  and  after  approval  by  the  board  is 
doing  excellent  service  in  the  field. 

Second,  the  lecture  film  for  women  has  been  completed  and  after  approval  by 
the  board  is  being  carefully  tested  out  before  selected  audiences  in  different 
parts  of  the  country. 

Third,  the  revision  of  the  lecture  film  for  men  has  been  completed  and  after 
approval  by  the  board  is  being  circulated  with  constantly  increasing  influence 
throughout  the  country. 

Fourth,  the  film  for  explaining  the  general  social  hygiene  program  which 
has  come  to  be  popularly  spoken  of  as  the  American  plan,  has  been  completed 
but  has  not  been  presented  to  the  board  for  final  approval  because  various  por- 
tions of  it  are  not  considered  by  the  motion-picture  committee  of  the  associa- 
tion to  be  best  adapted  to  the  purpose.  Experiments  have  been  going  forward 
for  some  months  testing  this  film  by  showings  to  audiences  in  various  parts  of 
the  country,  securing  the  comments  of  those  present,  and  then  modifying  the 
film  along  lines  indicated  by  the  consensus  of  the  opinions  secured.  It  is  expected 
shortly  to  have  all  the  debatable  points  covered  and  to  release  this  film  for 
public  use  as  soon  as  the  board  has  approved  it. 

Fifth,  the  film  for  use  in  normal  schools  in  instructing  teachers  has  been 
practically  completed,  but  has  not  been  presented  for  final  approval  of  the 
board,  as  it  is  likewise  in  the  process  of  final  testing. 

Sixth,  the  film  for  adolescent  boys  has  not  been  completed,  but  the  photo- 
graphic work  has  been  done  and  the  several  parts  of  the  film  are  now  being 
tested  out  with  various  audiences  in  boys'  departments  of  the  Young  Men's 
Christian  Association,  by  Scout  Clubs,  schools,  and  other  groupings  of  boys. 
As  soon  as  these  field  researches  are  completed  the  film  will  be  assembled 
and  tested  in  final  form,  prior  to  presentation  to  the  board  for  formal  approval. 

(2)  Literature: 

Substantial  progress  has  been  made  in  the  study  of  new  literature  along  all 
the  lines  agreed  upon. 

First,  printed  matter  for  illiterates  and  persons  of  limited  education  and 
foreign-language  material  has  been  worked  out  in  the  following  manner: 

(a)  A  complete  "lay-out"  of  pamphlet  material,  with  illustrations,  has 
been  made  for  work  with  the  colored  population,  and  this  material  is  now 
being  tested  out  on  a  large  scale  in  the  State  of  Tennessee,  where  the  associa- 
tion, in  cooperation  with  the  State  health  authorities  and  the  United  States 
Public  Health  Service,  is  still  engaged  on  a  demonstration  of  the  best  ways 
and  means  of  reaching  the  colored  population  with  informational  hygiene  of 
the  venereal  diseases. 


REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.     155 

(&)  For  special  uses  the  following  have  been  -worked  out  and  printed  in 
Yiddish : 

Warning  against  prostitutes 2,  000 

Facts  about  syphilis 2,500 

Facts  about  gonorrhea 2,  500 

Child  questions  and  answers 2,  500 

These  experimental  editions  have  been  circulated  for  observation  of  results 
and  the  observations  are  now  in  process  of  study  and  tabulation. 

(c)  For  simillar  purposes,  especially  in  the  Southwest,  the  following  have 
been  worked  out  and  printed  in  Spanish : 

Warning  against  prostitutes 2,500 

Facts  about  syphilis 2,  500 

Facts  about  gonorrhea 2,  500 

Child  questions  and  answers 2,  500 

(d)  For  use  in  the  north  Atlantic  States  and  in  many  other  parts  of  the 
coimtry  where  there  are  large  numbers  of  Italians  the  following  have  been 
printed : 

Warning  against  prostitutes 2,  500 

Facts  about  syphilis 2,  500 

Facts  about  gonorrhea 2,  500 

Child  questions  and  answers 2,  500 

Second,  a  series  of  eight  posters  has  been  developed.  These  have  run  on 
the  cover  of  the  monthly  bulletin  for  the  purpose  of  obtaining  a  consensus  of 
opinion  concerning  the  most  effective  of  the  series.  Of  the  latter  a  few  are 
being  prepared  for  use  of  State  boards  of  health  aud  educational  authorities. 
A  subsequent  series  of  eight  additional  posters  has  been  prepared  and  a  contest 
has  been  conducted,  with  awards  of  $10  prizes  for  the  best  designs  for  posters. 
A  special  poster  has  been  prepared  for  the  cover  page  of  the  pamphlet  in 
English  entitled  "  Child  Questions  and  Answers,"  of  which  5,000  have  been 
printed  for  distribution  among  the  members  of  parent-teachers  associations, 
branches  of  the  Congress  of  Mothers,  and  other  similar  organizations. 

A  good  many  photographs  have  been  taken  of  poster  groups  in  the  process  of 
developing  designs ;  additional  photographic  studies  of  social  customs,  conven- 
tions, manner  of  dress,  recreation,  entertainment,  and  living  and  working  con- 
ditions, bearing  directly  or  indirectly  upon  the  prevention  of  exposure  to 
venereal  disease,  have  been  planned  or  are  being  worked  out. 

On  behalf  of  the  directors  of  the  association  I  desire  to  take  this  occasion  to 
renew  our  expression  of  appreciation  of  the  cooperation  of  the  Interdepart- 
mental Board  in  promoting  the  important  developmental  work  which  has  been 
intrusted  to  this  organization.  I  think  it  may  be  stated  conservatively  that 
the  educational  facilities  which  have  been  made  possible  by  the  board  and 
already  released  to  the  public  have  given  evidence  of  their  importance  and 
increasing  value  in  promoting  both  informational  and  educational  hygiene  of 
venereal  disease.  ' 

REPORT  ON  THE  BUSINESS  OFFICE. 

The  business  division  of  the  board  has  been  given  the  above  desig- 
nation, and  is  composed  of  the  purchasing,  accounting,  auditing,  and 
paying  sections. 


156      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

The  duties  placed  under  this  division  are  necessarily  numerous^ 
but  our  experience  has  proven  that  by  thus  concentrating  within  one 
division  and  under  the  supervision  of  one  official  all  the  business 
affairs  of  the  board  it  tends  to  promote  both  efficiency  and  economy. 

The  system  of  accounting  and  filing  is  of  the  most  modern  and 
approved  type.  Each  appropriation  under  the  board  is  given  its 
special  ledgers  and  bookkeepers,  and  all  the  ledgers  in  use  are 
specially  printed  and  ruled  loose-leaf  books. 

All  the  most  important  books  and  documents  are  kept  in  fireproof 
combination  safes. 

Expenditures  from  appropriations  for  the  fiscal  year  ended  June 
30, 1920,  are  shown  in  detail  on  the  following  pages. 

Financial  summary,  fiscal  year  ended  June  30,  1920. 

(a)  Appi'opriation     "  Interclepartmental    Social    Hygiene    Board, 

1920  " $100,  000.  OO 

Amount  expended 93,  010.  09 

Unexpended    balance 6,  989.  91 

(&)  Appropriation  "Aid  to  States  in  protection  of  military  and 

naval  forces  against  venereal  diseases,  1920  " 784,  000.  00 

Amount  expended 387,  983.  83 

Unexpended  balance 396,  066. 17 

(c)  Appropriation  "Payments  to  States  for  the  prevention,  treat- 

ment, and  control  of  venereal  diseases,  1920  " 1,  087,  831.  42 

Amount  expended 991,  486. 12 

Unexpended  balance 96,  345.  30 

(d)  Appropriation   "Payments  to  universities,  etc.,   for  research 

in  educational  measures,  1920  " 439,  030.  00 

Amount  expended 437,  400.  50 

Unexpended  balance 1,  629.  50 

(e)  Appropriation   "Payments   to  universities,   etc.,   for  research 

venereal  diseases,  1920  " 103,  430.  00 

Amount  expended 103,  430.  00 

Unexpended  balance None. 

For  details  of  expenditures,  see  reference  letter. 

Detail  of  expenditures  from  appropriation   (a). 

[Appropriation :  "  Interdepartmental  Social  Hygiene  Board,  1920,"  $100,000.] 

Salaries  of  personnel $6^'  437.  71 

Office  supplies  and  equipment,  envelopes,  etc 14,  631.  51 

Railroad   transportation 3, 192.  00 

Traveling,  incidental  expenses,  and  per  diem  allowance 2,  038.  93 

Printing  and  binding 4,  409.  94 

Miscellaneous  expenses,  including  telephones,  telegraphing,  etc 2,  300.  00 

Total 93-  010.  09 


REPOET  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD.     157 

Detail  of  expenditures  frovi  appropriation  (&). 

T Appropriation  :  "Aid  to  States  in  protection  of  military  and  naval  forces  against  venereal 

diseases,  1920,"  §784,000.] 

Salaries $204,  268.  57 

Railroad    transportation 16,  548.  91 

Traveling  expenses  and  per  diem  allowance 35,  638.  82 

Office  expenses,  including  rentals  of  offices,  furniture,  purchase  of 

stationery,  telephone  costs,  telegraphing,  and  miscellaneous  items_  24,  345.  57 
Maintenance   of  venereally  infected  persons  in   institutions    (for 

details  see  below) 107, 131.  96 

Total 387,  933.  83 

^Statement  of  payments  to  detention  liouses,  etc.,  for  maintenance  of  venereally 
infected  persons,  fiscal  year  ended  June  30,  1920. 

1.  State  Training  School  for  Girls.  Birmingham,  Ala $1,  000.  00 

2.  AVard  L,  San  Francisco  Hospital,  San  Francisco,  Calif 8,  007.  00 

3.  Jefferson  County  Institutions,  Louisville,  Ky 3,  993.  25 

4.  Mercy  Hospital,  V.  D.  Detention  Ward,  Baltimore,  Md 100.  00 

5.  State  Department  of  Health  Hospital  No.  1,  Baltimore,  Md 2. 134. 11 

6.  Fairmount  Hospital,  Kalamazoo,  Mich 11,  909.  77 

7.  Female  Detention  Ward,  St.  Louis  City  Hospital,  St.  Louis,  Mo__  1,  233.  84 

8.  Florence  Crittenden  League,  New  York,  N.  Y 349.  50 

9.  State  Home  and  Industrial  School  for  Girls  and  Women,  Samar- 

cand,  N.  C 48,929.43 

10.  Akron  Welfare  Home  for  Women,  Akron,  Ohio _1  1,  860.  73 

11.  Cincinnati  General  Hospital,  Cincinnati,  Ohio 5.  934.  00 

12.  Anna  Finstrom  Detention  Hospital,  Columbia,  S.  C 3,  739.  .50 

13.  Shelby  Hospital,  Memphis,  Tenn 4,  658.  37 

14.  Chattanooga  Venereal  Quarantine  Hospital,  Chattanooga,  Tenn_  7,  200.  00 

15.  Texas  Girls'  Training  School,  Gainesville,  Tex 4, 136.  99 

16.  City  Hospital  and  City  Home,  Norfolk,  Va 1,  945.  47 


Total  paid 107, 131.  96 


SUMMARY. 


Average  number  of  venereally  infected  persons  in  above  institutions  for 

one  month 11,  493 

Actual  number  of  days'  treatment  given  by  above  institutions 96,  842 

Average  per  capita  cost  per  day $1- 11 

Detail  of  expenditures  frorn  appropriation  (c)  fiscal  year  ended  June  30,  1920. 

[Appropriation :    "  Payments    to    States  for   the   prevention,    treatment,    and    control    of 
venereal  diseases,  1920,"  $1,087,831.42.] 


Alabama $25,  288.  99 

Arizona 2,  250.  00 

Arkansas 17, 118.  74 

California 25,  800.  00 

Colorado 9,  450.  70 

Connecticut 12,  000.  00 

Delaware 2,  393.  02 

Di.strict  of  Columbia 

Florida 8,  90L  84 

Georgia 15,  000.  00 

Idaho .3,  540. 13 

Illinois 06,  692.  24 


Indiana $31,  945.  49 

Iowa - 15,  000.  00 

Kansas 20,  000.  24 

Kentucky 27,  084.  58 

Louisiana 19,  590.  46 

Maine 8,  07L  68 

Maryland 14,  651.  96 

Ma.ssachusetts 36,  602.  51 

Michigan 33,  238.  23 

Minnesota 24,  551. 10 

Mississippi 21,  2-55.  94 

Missouri 31,  969.  03 


158      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 


Montana $4,  447.  88 

Nebraska 12,  962..  75 

Nevada 

New  Hampshire 4,  981.  54 

New  Jersey 27,586.22 

New  Mexico 

New  York 107,  794. 18 

Nortli  Carolina 26,  095.  57 

Nortli  Daliota 6,274.24 

Ohio 25,  000.  00 

Oklahoma 19,  600.  53 

Oregon 7,  314.  87 

Pennsylvania 90,  661.  56 

Rhode  Island 6,  000.  00 


South  Carolina $17,  923.  88 

South  Dakota 5,000.00 

Tennessee 25,  841.  29 

Texas 45,  600.  00 


Utah 

Vermont 

Virginia 

Washington 

West  Virginia. 


4,  41^5.  92 

4,  210. 19 

24,  384.  37 

13,  507.  25 

12,  900.  00 

Wisconsin 25,  000.  00 


Wyoming- 


1,  587.  00 


Total 991,  486. 12 


Detail  of  expenditures  from  appropriations  (d),  fiscal  year  ended  June  30,  1920. 


"  Payments  to  universities,  etc.,  for  research  in  educational  measures, 
1920,"  $439,030.] 


[Appropriation 

Alabama : 

University  of  Alabama,  University $9,  500.  00 

Tuskegee  Normal  and  Industrial  Institute,  Tuskegee 9,  950.  00 

California  :  State  Normal  School,  San  Diego 75.  00 

Colorado  :  State  Teachers'  College,  Greeley 8,  631.  00 

■Florida  :  University  of  Florida,  Gainesville 10, 100.  00 

Illinois : 

Northwestern  University,  Evanston 10,  000.  00 

Northern  Illinois  State  Normal  School,  DeKalb 100.  00 

Indiana : 

Indiana  University,  Bloomington 7,  440.  00 

Teachers'  College  of  Indianapolis,  Indianapolis 75.  00 

Iowa: 

State  University  of  Iowa,  Iowa  City 15,  938.  52 

Iowa  State  College  of  Agriculture  and  Mechanic  Arts,  Ames 10, 000. 00 

Kentucky  :  University  of  Kentucky,  Lexington I 17,  600.  00 

Louisiana :  State  Normal  School,  Natchitoches 5,  750.  00 

Maryland : 

Maryland  State  Normal  School,  Towson 4,  600.  00 

Maryland  Normal  and  Industrial  School  (colored),  Bowie 1,960.00 

Johns  Hopkins  University,  Baltimore 5.  000.  00 

Massachusetts : 

Harvard  University,  Cambridge 13,  600.  00 

Massachusetts  State  Psychiatric  Institute,  Boston 2,000.00 

Michigan  :  Michigan  State  Normal  School,  Ypsilanti 6,  200.  00 

Minnesota  :   State  Normal  School,  Winona 5,  300.  00 

Mississippi :  University  of  Mississippi,  Oxford 20,  575.  00 

Missouri : 

State  Teachers'  College,  Kirkville 11,  920.  00 

University  of  Missouri,  Columbia 5,  722. 06 

New  Mexico  :  University  of  New  Mexico,  Albuquerque 6,  600.  00 

Nevada  :  University  of  Nevada,  Reno 6,  000.  00 

New   York : 

State  Normal  and  Training  School,  Oswego 7.650.00 

New  York  State  College  for  Teachers,  Albany 10, 161.  00 

Cornell  University,  Ithaca 37,  065.  00 

Teachers'  College,  Columbia  University,  New  York  City 5,  000.  00 

College  of  the  City  of  New  York,  New  York  City 375.  00 

American  Social  Hygiene  Association,  New  York  City,  14  re- 
searches   48,  500.  00 


EEPOKT  V.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.     159 

North  Carolina :  North  Carolina  College  for  Women,  Greensboro $10,  800.  00 

North  Dakota :  State  Normal  School,  Valley  City 4,  500.  00 

Ohio  :  University  of  Cincinnati,  Cincinnati 12,  000.  00 

Oregon : 

University  of  Oregon,  Eugene 10,  000.  00 

Reed  College,  Portland 2,  200.  00 

Pennsylvania :    Women's   Medical   College   of   Pennsylvania,   Phila- 
delphia   3,  376.  73 

South  Carolina  :  University  of  South  Carolina,  Columhia 6,  570.  00 

South  Dakota  :  Northern  Normal  and  Industrial  School,  Aberdeen 11,  433.  00 

Tennessee : 

University  of  Tennessee,  Knoxville 9,  250.  00 

Peabody  College  for  Teachers,  Nashville 10,  000.  00 

Fisk  University,  Nashville 10,  000.  00 

Utah  :  University  of  Utah,  Salt  Lake  City 12,  000.  00 

Virginia :  Hampton  Normal  and  Agricultural  Institute,  Hampton 6,  000.  00 

Washington : 

State  Normal  School,  Cheney 3,  808.  30 

State  Normal  School,  Bellingham 10,300.00 

Wisconsin  :  Milwaukee  State  Normal  School,  Milwaukee 11,  774.  89 

Total 437,  400.  50 

Detail  of  expenditures  from  appropriation  (e)  fiscal  year  ended  June  80,  1920. 

[Appropriation :    "  Payments   to   universities,   etc.,   research    venereal   diseases,    1920," 

$103,430.] 

California : 

Leland  Stanford  University  Medical  School,  San  Francisco—  $885.  00 

University  of  California,  Berkeley 3,875.00 

Illinois : 

John  McCormick  Institute  for  Infectious  Diseases,  Chicago 3,  000.  00 

Northwestei-n   University,   Evanston 6,  000.  00 

University    of    Illinois,    Urbana 3,500.00 

Iowa  :  University  of  Iowa,  Iowa  City _ 5,  320.  00 

Maryland :  Johns  Hopkins  University,  Baltimore,  four  researches-  19,  050.  00 

Massachusetts : 

Massachusetts    State    Psychiatric    Institute,    Boston 13, 200. 00 

Harvard    Medical    School,    Boston 10,000.00 

Minnesota :  University  of  Minnesota  Medical  School,  Minneapolis, 

three   researches 9,  000.  00 

Missouri : 

St.  Louis  University  School  of  Medicine,  St.  Louis 4,  000.  00 

Washington  University   School  of  Medicine,- St.   Louis 4,000.00 

New  York : 

Columbia  University  College  of  Physicians,  New  York 4,  200.  00 

New  York  University  and  Bellevue  Hospital,  New  York 5,  400.  00 

Wisconsin  :  University   of   Wisconsin,   Madison 12,  000.  00 

Total - 103,  430.  00 


Pakt  III. 

Ixfracts  Covering  Activities  for  the  Year  Ending  June  30,  1919,  Taken  From  the  Manual  for  the 
Various  Agents  of  the  United  States  Interdepartmental  Social  Hygiene  Board. 


INTRODUCTION. 

BACKGROUND  AND  PURPOSES  OF  LAW  CREATING  THE  BOARD, 

The  compelling  events  of  the  Great  War  very  early  focused  the  at- 
tention of  the  world  upon  the  fundamental  importance  of  man  power. 
The  remark  that  the  war  would  be  won  by  the  side  that  could  fight 
for  the  last  15  minutes  was  taken  at  its  face  value.  The  conservation 
of  man  power  came  to  be  a  dominating  factor  in  the  plans  of  each  of 
the  warring  nations. 

When  the  United  States  entered  the  war  the  medical  service  of 
the  Army  and  the  medical  service  of  the  Navy  were  ready  with 
practical  plans  for  the  prevention,  treatment,  and  control  of  malaria, 
typhoid,  typhus,  and  smallpox,  each  of  which  has  a  military  history 
of  greater  morbidity  and  greater  mortality  than  all  the  weapons  of 
warfare  in  all  the  great  armies  of  all  history  combined.  Very  recent 
military  history  had  demonstrated  the  practical  values  of  scientific 
hygiene  for  the  prevention,  treatment,  and  control  of  these  diseases 
in  the  Army,  in  the  Navy,  and  in  the  civilian  population  upon 
which  armed  forces  depend  in  so  many  ways  for  safety  and  support 
and  recruits.  The  United  States  made  use  of  this  information  and 
in  consequence  the  Medical  Corps  of  the  Army,  the  Medical  Corps 
of  the  Navy,  and  the  Public  Health  Service  of  the  Treasury  saved 
an  enormous  resource  in  American  man  power  that  otherwise  would 
have  been  needlessly  sacrificed  to  these  diseases. 

But  there  is  a  group  of  other  diseases  of  well-known  military, 
naval,  and  civilian  danger  that  had  not  been  successfully  controlled 
in  previous  wars.  Gonorrhea,  syphilis,  and  chancroid  have  been 
among  the  determining  factors  in  all  the  great  wars  for  many  cen- 
turies. Their  causes,  carriers,  injuries,  and  preventions  have  been 
known  for  a  number  of  years,  but  up  to  this  great  war  no  thoroughly 
organized,  systematic,  and  relatively  complete  program  had  been  de- 
veloped and  applied  for  the  prevention,  treatment,  and  control  of 
these  diseases. 
160 


REPORT  U.S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     161 

Even  before  the  United  States  entered  the  Great  War,  govern- 
mental and  civilian  experts  began  laying  plans  for  the  control  of 
gonorrhea,  syphilis,  and  chancroid.  The  most  powerful  of  these  pre- 
war stimuli  came  from  the  American  Social  Hygiene  Association, 
a  voluntary  civilian  organization  that  for  a  number  of  years  had 
been  gathering  scientific  information  and  laying  carefully  organized 
plans  for  the  control  of  the  venereal  diseases. 

As  a  result  of  these  influences,  the  venereal  disease  programs  of  the 
Army  and  the  Navy  were  effectively  organized  soon  after  the  United 
States  entered  the  war. 

But  no  program  of  protective  hygiene  can  possibly  succeed  in 
defending  the  Army  or  the  Navy  from  military  diseases  and  espe- 
cially from  the  venereal  diseases  unless  that  program  protects  also  the 
civilian  population.  Knowing  that  venereal  disease  is  much  more 
common  in  the  civilian  population  than  in  the  Army  or  Navy ;  know- 
ing that  every  soldier  or  sailor  with  gonorrhea,  syphilis,  or  chan- 
croid secured  his  infection  from  a  civilian  source ;  knowing  that  the 
civilian  prostitute,  male  and  female,  is  in  a  large  measure  respon- 
sible for  the  dissemination  of  venereal  disease ;  and  knowing  that  the 
prostitute  is  not  a  local  or  regional,  but  rather  a  national  liability, 
the  well-informed  authorities  concerned  applied  to  Congress  for  legis- 
lative action  that  would  enable  the  War  Department,  the  Navy  De- 
partment, and  the  Treasury  Department  to  join  together  to  assist 
the  States  to  meet  their  very  important  obligations  and  i3omplete  the 
American  program  for  the  prevention,  treatment,  and  control  of 
the  venereal  diseases. 

The  startling  facts  that  led  Congress  to  enact  the  law  which  es- 
tablished the  Interdepartmental  Social  Hygiene  Board  and  the  defi- 
nite purposes  for  which  that  legislation  was  proposed,  are  stated 
in  the  records  of  a  hearing  held  before  a  subcommittee  of  the  Senate 
Committee  on  Military  Affairs  on  June  18,  1918.  The  evidence  pre- 
sented at  this  hearing  was  furnished  by  a  group  of  men  who  are 
known  to  be  among  those  most  expertly  qualified  to  furnish  reliable 
information  on  the  community,  State,  and  National  menace  of  vene- 
real diseases. 

The  defensive,  protective,  and  remedial  proposals  made  to  and  ap- 
proved by  the  committee,  and  supposedly  contained  in  the  act  as 
finally  submitted,  were  approved  by  the  House  of  Representatives 
and  by  the  Senate,  and  the  act  carrying  this  presentation  of  the  law 
was  signed  by  the  President  on  July  9,  1918.  These  proposals  may 
be  stated  concisely  as  follows : 

To  assist  the  various  States  in  caring  for  civilian  persons  whose 
detention,  isolation,  quarantine,  or  commitment  to  institutions  may  be 
found  necessary  for  the  protection  of  the  military  and  naval  forces 
1.5610—20 11 


162      REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD. 

of  the  United  States  against  venereal  diseases  during  the  war  and 
after  the  war ; 

To  protect  the  civilian  population  against  venereal  diseases  during 
the  war  and  after  the  war ; 

To  assist  States  in  building  reformatories  and  detention  houses 
for  hygienic,  social,  and  economic  redemption  and  restoration  of 
venereal-disease  carriers  ; 

To  assist  States  in  the  cure  of  persons  with  venereal  diseases ; 

To  assist  States  in  the  eradication  of  venereal  diseases ; 

To  assist  colleges,  universities,  and  other  suitable  institutions  to 
carry  out  scientific  research  for  the  discovery  of  better  medical 
methods  for  the  treatment  and  prevention  of  venereal  diseases; 

To  assist  colleges,  universities,  and  other  suitable  institutions  in 
the  instruction  of  their  students  concerning  the  defensive  hygiene  of 
venereal  disease. 

A  copy  of  the  act  is  appended.     ( See  Appendix  A. ) 

Summary  or  the  Work  of  the  Board  for  the  Period  Ending 

June  30,  1919. 

The  board  is  made  up  of  the  Secretary  of  the  Treasury,  the  Secre- 
tary of  War,  the  Secretary  of  the  Navy,  and  a  representative  chosen 
by  the  Secretary  of  the  Treasury  from  the  United  States  Public 
Health  Service,  a  representative  chosen  by  the  Secretary  of  War 
from  the  Medical  Corps  of  the  United  States  Army,  and  a  repre- 
sentative chosen  by  the  Secretary  of  the  Navy  from  the  Medical 
Corps  of  the  United  States  Navy.  This  act  of  Congress  carried  with 
it  an  appropriation  of  something  over  $4,000,000  which  was  made 
available  for  a  period  of  two  years. 

One  million  dollars  of  this  sum  was  set  aside  for  payment  to  States 
for  expenditure  through  their  boards  of  health  for  the  prevention, 
treatment,  and  control  of  venereal  diseases.  This  appropriation  of 
$1,000,000  was  repeated  for  the  year  beginning  July  1,  1919.  A 
second  appropriation  of  $200,000  was  made  for  the  establishment  of 
a  division  of  venereal  diseases  in  the  United  States  Public  Health 
Service.  This  Division  was  directed  by  the  law  to  study  and  investi- 
gate the  causes,  treatment,  and  prevention  of  venereal  diseases,  to 
cooperate  with  State  boards  or  departments  of  health  for  the  pre- 
vention and  control  of  such  diseases  within  the  States ;  and  to  control 
and  prevent  the  spread  of  these  diseases  in  interstate  traffic.  A  third 
appropriation  of  $1,000,000  was  made  for  the  purpose  of  assisting 
States  in  caring  for  civilian  persons  whose  detention,  isolation,  quar- 
antine, or  commitment  to  institutions  would  protect  the  armed  mili- 
tary and  naval  forces  of  the  United  States  from  venereal  diseases.  A 
fourth  appropriation  of  $100,000  was  made  for  the  present  year  and 


REPORT  U.  S.  I2!TTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      168 

repeated  for  the  ensuing  fiscal  year  for  the  purpose  of  assisting  sucli 
colleges,  uniAersities,  and  other  institutions  as,  in  the  judgment  of 
the  Interdepartmental  Social  Hygiene  Board,  are  qualified  for  scieji- 
tific  research  to  discover  more  effective  medical  measures  for  the 
treatment  and  prevention  of  venereal  diseases.  And  finally  the  law 
carried  an  appropriation  of  $300,000  for  the  first  fiscal  year  (1919) 
and  of  $300,000  for  the  second  year  which  "  shall  be  paid  to  such 
universities,  colleges,  or  other  suitable  institutions  or  organizations 
as,  in  the  judgment  of  the  Interdepartmental  Social  Hj^giene  Board, 
are  qualified  for  scientific  research  for  the  purpose  of  discovering  and 
developing,  in  accordance  with  the  rules  and  regulations  prescribed 
by  the  Interdepartmental  Social  Hygiene  Board,  more  effective  edu- 
cational measures  in  the  prevention  of  venereal  diseases  and  for  the 
purpose  of  sociological  and  psychological  research  related  thereto.'- 
The  work  of  the  board  has  been  very  seriously  handicapped  because 
of  certain  inadvertences  in  the  wording  of  the  law  which  brought 
the  board  into  existence.  Nevertheless  a  great  deal  has  been  accom- 
plished through  the  application  of  these  several  funds.  A  tremendous 
campaign  along  the  lines  of  information  relating  to  the  individual, 
group,  and  intergroup  hygiene  of  venereal  diseases  has  been  carried 
on  by  the  Division  of  Venereal  Diseases  of  the  United  States  Public 
Health  Service  and  by  the  commissions  on  training-camp  activities. 
Practically  all  of  the  States  in  the  United  States  have  passed  laws 
or  adopted  regulations  for  the  control  of  these  diseases  in  accordance 
with  the  recommendations  of  the.  Secretary  of  the  Treasury  and  the 
Interdepartmental  Social  Hygiene  Board.  All  of  the  States  with 
the  exception  of  three  have  availed  themselves  of  the  appropriation 
set  aside  for  the  use  of  their  boards  of  health  for  the  prevention, 
treatment,  and  control  of  venereal  diseases.  Most  of  these  States 
qualified  for  the  appropriation  set  aside  for  them  for  the  second 
fiscal  year  on  the  condition  that  for  each  dollar  received  by  a  State 
from  the  Government  under  this  appropriation  the  State  should 
set  aside  a  dollar  from  its  own  treasury.  The  appropriation  for 
assisting  States  in  caring  for  infected  civilian  persons^  in  order  to 
protect  soldiers  and  sailors  from  venereal  diseases,  has  been  spent 
this  year  (1919)  largely  through  the  law  enforcement  division  of  the 
commissions  on  training-camp  activities.  The  commissions  on  train- 
ing-camp activities  have  been  greatly  reduced  in  personnel,  and  the 
law-enforcement  division  has  become,  as  a  result,  the  field  service  of 
the  Interdepartmental  Social  Hygiene  Board.  This  field  service  has- 
accomplished  a  tremendously  important  piece  of  work.  Among  other 
things,  it  has  taken  care  of  over  30,000  delinquent  women  and  girls 
who  were  detained  in  the  neighborhoods  of  military  and  naval  camps 
and  has  either  sent  them  home,  placed  them  on  parole,  or  committed 
them  to  institutions  for  care  and  treatment. 


164      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

The  combined  program  of  the  Army,  the  Navy,  the  Public  Health 
Service,  the  commissions  on  training  camp  activities,  and  the  United 
States  Interdepartmental  Social  Hygiene  Board  resulted  in  a  re 
markable  reduction  of  venereal  infection  in  the  Army  and  in^  the 
Navy  during  the  war.  Just  as  we  succeeded  in  reducing  or  eliminat- 
ing typhoid  or  typhus  fever  and  other  serious  diseases  when  we 
wisely  applied  scientific  knowledge  and  when  we  spent  money  in  suffi- 
cient amounts,  so  we  have  succeeded  in  reducing  enormously  the 
occurrence  of  venereal  infections,  now  that  we  have  used  the  avail- 
able scientific  knowledge  and  have  spent  money'  intelligently  for  that 
purpose.  No  army  in  the  history  of  the  world  has  enjoyed  the 
freedom  from  these  diseases  which  the  American  Army  has  secured. 
A  number  of  interesting  facts  have  been  brought  up  in  connection 
with  this  whole  program.  In  the  first  place,  it  seems  to  be  true  that 
in  the  civilian  population,  without  any  systematic  control,  venereal 
infections  may  be  ten  times  as  numerous  as  in  the  Army  and  Navy 
under  the  systematic  and  regular  control  that  obtains  there.  It  has 
been  found  that  a  soldier  with  venereal  infection  is  usually  able 
to  do  some  kind  of  work  after  about  10  days  in  the  hospital,  and  that 
it  is  very  much  better  for  the  soldier  that  he  be  given  work  as  soon  as 
it  is  reasonably  possible  to  do  so.  It  may  be  said  therefore  that  every 
case  of  venereal  infection  means  a  loss  of  at  least  10  days  on  the  part 
of  the  man  concerned.  It  must  not  be  forgotten,  however,  that  none 
of  them  is  able  to  work  at  full  normal  capacity  so  soon,  and  that 
some  men  become  incapacitated  for  life.  It  would  be  safe  to  state 
that  the  incapacity  resulting  from  venereal  disease  persists  usually 
for  several  weeks  and  sometimes  for  life. 

Between  September,  1917,  and  February  14,  1919,  there  were  over 
220,000  cases  of  venereal  disease  in  the  Army,  and  there  were  over 
60,000  cases  in  the  Navy.  Our  record,  then,  was  somewhere  in  the 
neighborhood  of  300,000  cases,  causing  the  Army  and  Navy  to  lose  a 
minimum  of  3,000,000  days  of  service.  If  there  had  not  been  an 
efficient  program  of  venereal  disease  control,  with  its  educational,  in- 
formational, protective,  and  preventive  elements  operating  in  the 
camp  and  outside  of  the  camp,  we  would  have  had  five  times  as  many 
cases  of  venereal  disease  and  we  would  have  lost  more  than  five  times 
that  amount  of  time  and  human  service  because  of  those  diseases. 
The  United  States  Government  by  spending  several  million  dollars 
in  this  campaign  and  by  using  the  expert  service  of  some  of  the  best- 
equipped  men  and  women  in  America  has  saved  a  million  or  more 
young  men  from  infections  that  would  have  incapacitated  them  all 
for  at  least  10  days  and  some  of  them  for  life— infections  that  would 
have  injured  not  only  them  but  many  others  with  whom  they  would 
come  in  contact.  This  investment  has  been  of  priceless  value  to  the 
Government  and  to  the  men  for  whom  it  was  made,  and  to  the  home.s 


REPOKT  U.  S.   mTERDEPARTMENTAL  SOCUAL  HYGIENE  BOARD.      165 

and  families  of  those  men.  It  gives  us  an  example  of  what  can  be 
done  by  intensive  ^organization  for  the  control  of  this  particular 
group  of  agencies  that  injure  human  health. 

Our  fund  for  the  encouragement  of  scientific  research  is  being 
distributed  to  institutions  whose  representatives  come  to  us  with 
medical  problems  concerning  the  prevention  and  treatment  of 
venereal  disease,  which  these  institutions  cannot  solve  without 
financial  help.  The  board  has  made  some  distributions  already  and 
is  negotiating  with  a  number  of  institutions  relative  to  other  appro- 
priations. Up  to  July  1,  1919,  appropriations  were  made  to  14  uni- 
versity laboratories  located  in  11  States  for  the  purpose  of  investigat- 
ing 27  important  problems  in  the  prevention  and  treatment  of  ve- 
nereal diseases.  At  the  present  time  40  of  the  most  capable  and  best- 
known  students  of  scientific  medicine  in  America  are  engaged  in 
directing  and  carrying  out  these  researches.  With  them  are  asso- 
ciated a  number  of  younger  promising  scientific  investigators. 

The  Interdepartmental  Social  Hygiene  Board  has  taken  the  posi- 
tion that  education  for  the  prevention  of,  avoidance  of,  and  protec- 
tion from  venereal  diseases,  and  unwise  and  injurious  sex  life  should 
not  be  developed  through  a  special  and  dramatic  emphasis  of  those 
subjects,  but  rather  through  their  normal  consideration  in  their 
proper  and  regular  relation  with  the  other  important  divisions  and 
subdivisions  of  hygiene.  Furthermore,  the  board  takes  the  position 
that  the  greatest  amount  of  permanent  influence  may  be  achieved 
if  the  regular  classroom  teacher  is  prepared  in  general  hygiene  as 
thoroughly  as  she  is  prepared  in  English  or  geography  or  mathe- 
matics. With  these  principles  in  mind,  the  board  has  proposed  to 
assist  each  State  in  the  United  States  that  will  accept  this  assistj^nce, 
to  establish  in  one  of  its  normal  schools,  colleges,  or  universities  that 
trains  teachers,  a  department  of  hygiene  that  will  reach  every 
teacher  in  training  in  that  institution,  so  that  upon  graduation  the 
prospective  teacher  will  have  had  as  a  part  of  his  or  her  preparation 
for  life  work,  training  secured  in  a  required,  expertly  supervised 
curriculum,  including  courses  and  conferences  in  informational  hy- 
giene and  courses  and  conferences  in  the  applications  of  hygiene 
wherein  are  emphasized  with  appropriate  and  due  proportion  and 
proper  tact  and  persistency  the  serious  importance  of  the  venereal 
diseases,  their  causes,  carriers,  and  prevention,  and  at  the  same  time, 
with  all  the  consideration  they  deserve,  emphasis  is  given  to  the 
other  important  facts,  and  applications  of  general,  individual,  group, 
and  intergroup  hygiene.  The  board  is  interested  not  only  in  this 
training  for  teachers  but  also  in  such  a  training  for  all  college  and 
university  students.  Up  to  June  30, 1919,  the  board  had  made  appro- 
priations for  the  assistance  of  normal  schools,  colleges,  and  uni- 


166      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

versities  in  the  establishment  of  departments  of  hyo;iene  in  22  edu- 
cational institutions  situated  in  18  States. 

It  is  wholly  obvious  that  it  is  only  through  some  such  method  of 
approach  as  this  that  we  will  be  able  to  influence  our  future  citizen- 
ship to  protect  itself  through  habits  of  individual,  group,  and  inter- 
group  hygiene  from  the  venereal  diseases,  as  well  as  from  the  great 
variety  of  damaging  agencies  of  similar  character  with  which  the 
race  has  to  contend.  While  it  is  true  that  one  can,  within  limits,  buy 
health,  and  while  it  is  true  that  the  city  or  the  nation  that  will  spend 
its  money  can  buy  protection  from  the  agencies  that  destroy  life  and 
damage  health,  it  is  nevertheless  equally  true  that  there  is  a  point  be- 
yond which  your  dollar  and  the  dollars  of  the  Nation  can  not  go  for 
the  purchase  of  vigor,  physiological  efficienc'^%  and  enduring  life.  Be- 
yond that  point  the  individual  must  provide  his  own  protection,  and 
he  must  supply  this  protection  through  his  habits  of  living.  He 
must  achieve  this  greater  physiological  efficiency,  this  better  health, 
through  his  own  physical  education.  If  the  United  States  Interde- 
partmental Social  Hygiene  Board  succeeds  in  demonstrating  the 
practical  value  of  departments  of  hygiene  in  training  schools  for 
teachers,  and  in  colleges  and  universities,  the  Government  will  have 
accomplished  one  of  the  most  important  tasks  that  lies  between  us  and 
the  achievement  of  more  perfect  national  vitality  and  of  national 
health.  If  every  parent  and  every  other  teacher  of  children  were 
in  possession  of  safe,  general  knowledge  of  the  elements  of  hygiene, 
the  children  would  profit  enormously  through  their  home  and  school 
experiences,  and  we  would  be  supplied  ultimately  with  a  very  much 
more  complete  program  of  defense  against  the  agencies  that  destroy 
the  health,  the  man  power,  and  the  woman  power  of  the  Nation. 

PERIOD   OF   ORGANIZATION. 

Pursuant  to  the  provisions  of  the  act  of  July  9, 1918,  the  board  met 
on  August  8,  1918,  for  the  purpose  of  organizing.  The  members  of 
the  board  at  that  time  were : 

William  G.  McAdoo,  Secretary  of  the  Treasury,  represented  by 
Judge  J.  H.  Moyle,  Assistant  Secretary  of  the  Treasury. 

Newton  D.  Baker,  Secretary  of  War. 

Josephus  Daniels,  Secretary  of  the  Navy. 

Lieut.  Col.  W.  F.  Snow,  Medical  Corps  United  States  Army. 

Lieut.  Commander  J.  E.  Phelps,  Medical  Corps  United  States 
Navy. 

Asst.  Surg.  Gen.  C.  C.  Pierce,  United  States  Public  Health  Service. 

'Secretary  Daniels  was  elected  chairman  and  Asst.  Surg.  Gen. 
Pierce  was  made  temporary' secretary.  An  executive  committee  was 
organized,  the  membership  of  which  was  composed  of  Lieut.  .Col. 
Snow,  Lieut.  Commander  Phelps,  and  Asst.  Surg.  Gen.  Pierce. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD.     167 

Acting  on  informal  advice  secured  from  the  office  of  the  Comp- 
troller of  the  Treasury,  the  board  appointed  a  disbursing  agent  on 
September  3,  1918,  through  regular  civil-service  channels.  After  a 
search  for  an  available  man  competent  to  serve  as  an  executive  sec- 
retary, the  board  made  appointment  to  the  position  October  12,  1918. 

The  board  proceeded  immediately  to  adopt  measures  for  the  ac- 
complishment of  the  purposes  that  weve  defined  in  the  hearings  that 
preceded  the  passage  of  the  act.  These  purposes  the  board  had  every 
reason  to  believe  were  the  intent  of  the  act  resulting  from  the  hear- 
ing. Communications  were  developed  with  competent  State  authori- 
ties and  public-spirited  citizens,  for  the  assistance  of  the  States  in  ac- 
cordance with  well-known  plans  of  the  framers  of  the  act.  It  very 
soon  became  evident  that  the  intent  of  the  framers  of  the  act  was  not 
carried  in  whole  by  the  provisions  of  the  statute  and  that  the  law 
establishing  the  Interdepartmental  Social  Hygiene  Board  contained 
certain  inadvertencies  of  a  very  serious  character.  One  by  one  the 
delaying  influences  of  these  inadvertencies  became  evident.  As  a  re- 
sult, the  administrative  organization  and  functional  activities  of  the 
board  fell  naturally  into  three  periods — a  period  of  delayed  organiza- 
tion pending  an  authoritative  interpretation  of  the  law,  a  period 
of  incomplete  administration  because  of  insufficient  financial  re- 
sources, a  period  of  final  organization  which  will  consume  a  large 
p|irt  of  the  second  fiscal  year  in  the  life  of  the  board. 

Period  of  Interpretation. 

The  period  roughlj^  extending  from  July  to  December,  1918,  may 
be  designated  as  the  "  period  of  delayed  administrative  organization 
or  interpretation."  The  delay  was  due  to  loss  of  time,  first  because  of 
necessary  processes  in  the  office  of  the  Comptroller  of  the  Treasury 
leading  up  to  decisions  for  the  board,  and  second  because  of  inevitable 
loss  of  time  in  connection  with  the  formulation  of  an  application  for 
an  emergency  resource  with  which  to  maintain  the  board  until  con- 
gressonal  amendment  could  be  secured  to  correct  the  situation  that 
had  developed. 

The  duties  of  the  board,  in  certain  cases,  were  not  by  any  means 
clear  in  the  law  as  passed  or  in  conformity  with  the  supposed  in- 
tention. The  original  bill  as  proposed  to  the  Senate  committee  and 
as  printed  in  the  record  of  the  hearing  of  June  18,  1918,  contained 
six  sections.  Subsequently  section  5  of  the  proposed  bill  was  divided 
into  sections  5,  6,  and  7.  Unfortunately  this  subdivision  was  not  ac- 
companied by  a  revision  of  section  1,  which  carried  two  specific  ref- 
erences to  section  5  as  it  stood  in  the  original  bill,  references  relating 
to  the  duties  of  the  board,  namely:  "  (1)  To  recommend  rules  and 
'regulations  for  the  expenditure  of  moneys  allotted  to  the  States  under 


168      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

section  5  of  this  chapter;  (2)  to  select  the  institutions  and  organiza- 
tions and  fix  the  allotments  to  each  institution  under  said  section  5." 

After  the  original  section  5  to  which  these  references  were  made 
had  been  subdivided  into  sections  5,  6,  and  7,  neither  one  of  the  two 
references  was  concerned  with  the  new  section  5.  In  the  bill  as  it 
was  changed  and  passed  finally,  both  of  the  references  in  section  1 
applied  to  the  new  section  6.  It  is  obvious  that  difficulties  became  at 
once  imminent  and,  as  the  law  now  reads,  it  would  seem  that  the 
board  has  no  function  in  relation  to  the  rules  and  regulations  govern- 
ing the  expenditure  of  moneys  allotted  to  the  States  under  the  new 
section  6  and  only  a  limited  function  in  the  relation  to  the  selection 
of  institutions  and  allotments  under  the  new  section  6. 

The  matter  was  brought  to  the  attention  of  the  Comptroller  of 
the  Treasury,  who  pointed  out:  "The  terms  of  the  appropriation 
under  section  5  do  not  provide  for  allotments  to  States,  institutions, 
and  organizations.  Such  an  appropriation  is  provided  for  by  section 
6  of  this  act,  but  the  allotments  to  the  States  are  to  be  in  accordance 
with  rules  and  regulations  prescribed  by  the  Secretary  of  the  Treas- 
ury and  those  to  organizations,  institutions,  etc.,  under  the  board. 
The  duties  of  the  board  and  the  appropriations  are  thus  not  properly 
designated  in  connection  with  the  statutory  provisions." 

Again,  when  the  board  took  up  the  question  of  assisting  the  various 
States  "  in  caring  for  civilian  persons  whose  detention,  isolation, 
quarantine,  or  commitment  to  institutions  may  be  found  necessary  for 
the  protection  of  the  military  and  naval  forces  of  the  United  States 
against  venereal  disease,"  the  board  was  confronted  with  another  un- 
expected term.  The  policy  was  adopted  of  aiding  the  States  in  con- 
formity with  this  provision  through  assistance  granted  in  the  con- 
struction of  reformatories.  The  Comptroller  of  the  Treasury,  how- 
ever, gave  a  ruling  holding  that  none  of  the  money  appropriated  by 
the  act  for  this  purpose  could  be  spent  for  the  construction  or  repair 
of  any  institution.  The  board  could  not  undertake  to  build  or  repair 
structures  not  on  Government  property.  Another  serious  inadvertency 
was  discovered  in  the 'wording  of  section  7,  which  carried  an  appro- 
priation of  $100,000  intended  for  use  in  the  administrative  organiza- 
tion of  the  board.  Because  of  the  wording  of  the  clause,  however, 
the  board  was  informed  that  none  of  this  $100,000  could  be  used  for 
the  employment  of  personnel  or  for  the  organization  of  a  cejitral 
office. 

This  matter  was  taken  up  with  the  Comptroller  of  the  Treasury, 
who  pointed  out  that  the  law  as  it  stood  appropriated  the  sum  of 
$100,000  to  be  used  "  for  any  purpose  for  which  any  of  the  appro- 
priations made  by  this  chapter  are  available,"  and  since  "none  of 
the  appropriations  are  for  the  expenses  of  an  organization  of  ther 
board  "  none  of  the  $100,000  could  be  used  for  this  purpose. 


REPORT  U.  S.  INTERDEPARTMENTx\L.  SOCIAL  HYGIENE  BOARD.     169 

To  meet  the  emergency  application  was  made  to  the  President  for 
assistance  from  his  national  security  and  defense  fund,  in  order  that 
the  board  might  have  funds  with  which  to  administer  its  various 
activities.  The  application  was  granted  by  the  President  and  a  total 
of  $20,000  set  aside  from  the  national  security  and  defense  fund  to 
meet  the  administrative  expenses  of  the  board,  one  appropriation 
being  made  November  8  and  the  second  November  20. 

During  this  period  of  delayed  organization,  the  administrative 
personnel  of.  the  board  consisted  of  the  executive  secretary,  a  dis- 
bursing and  accounting  agent,  and  three  stenographers.  Two  of  the 
stenographers  were  furnished  by  an  agency  other  than  the  board, 
and  the  others  making  up  the  personnel  in  the  office  of  the  board  were 
without  salaries  until  the  emergency  fund  was  made  available. 

Proposed  Amendments  and  Their  Fate. 

After  discovering  the  various  inadvertencies  in  the  act  creating  it, 
the  board  made  every  reasonable  effort  to  secure  corrective  amend- 
ments through  Congress.  A  general  amendment  to  the  act  was 
drawn  up,  which  it  was  believed  would  correct  all  of  the  diffi- 
culties, make  the  law  and  the  purposes  of  its  framers  coincide, 
and  permit  the  Interdepartmental  Social  Hygiene  Board  to  carry 
on  to  the  full  the  duties  placed  upon  it  by  Congress.  The  cor- 
rections proposed  were  approved  by  the  various  committees  to  which 
they  were  presented  in  the  Sixty-fifth  and  also  the  Sixty-sixth 
Congress. 

In  January,  1919,  the  amendments  were  included  in  the  Army 
appropriation  bill,  which  "  died  "  in  the  Senate  March  4,  1919.  In 
May,  1919,  the  amendments  were  introduced  by  way  of  the  Appropria- 
tions Committee  of  the  Senate,  and  were  removed  with  a  number  of 
other  proposed  amendments  by  the  conference  committee  on  the  sun- 
dry civil  bill  of  the  Senate  and  the  House, 

Fortunately,  the  sundry  civil  bill  as  finally  enacted  in  July,  1919, 
authorized  the  board  to  use  its  resources  of  $100,000  for  administra- 
tive purposes.  It  will  be  seen,  however,  that  this  authority  came 
virtually  a  year  after  the  board  was  legally  established.  In  the 
meantime  the  board  was  supported  by  a  very  inadequate  financial 
administrative  resource — a  total  of  $20,000 — with  which  to  admin- 
ister four  appropriations  aggregating  $2,400,000,  and  covering  a 
number  of  complicated  administrative  activities. 

Period  of  Incomplete  Administrative  Organization. 

The  period  of  incomplete  administrative  organization  of  the  Inter- 
departmental Social  Hygiene  Board  extended  from  the  date  of  the 
receipt  of  financial  assistance  from  the  national  security  and  defense 


170     REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

fund,  to  the  end  of  the  fiscal  year  ending  June  30, 1919.  The  request 
for  $20,000  from  the  emergency  fund  was  originally  intended  to 
cover  the  administrative  expenses  of  the  board  up  to  March  4,  1919, 
by  which  time  it  was  confidently  expected  that  Congress  would  have 
enacted  corrective  amendments  making  available  to  the  board  the 
appropriation  originally  intended  for  administrative  purposes. 
When  these  amendments  were  not  acted  upon  by  Congress  the  board 
adopted  the  only  policy  open  to  it  for  the  remainder  of  the  fiscal  year, 
namely,  the  restriction  of  its  activities  to  limitations  imposed  by  the 
amount  of  administrative  financial  resources  at  its  disposal. 

During  this  period  an  administrative  organization  was  developed 
by  the  board  for  the  purpose  of — 

1.  Maintaining  a  satisfactory  record  of  disbursements  and  accounts 
in  connection  with  each  of  the  five  funds  for  which  the  board  was 
responsible  in  whole  or  in  part. 

2.  Assisting  States  in  the  "  care  of  civilian  persons  whose  detention, 
isolation,  quarantine,  or  commitment  to  institutions  may  be  found 
necessary  for  the  protection  of  the  military  and  naval  forces  of  the 
United  States  against  venereal  diseases." 

3.  Selecting  by  correspondence  and  expert  investigation  and  mak- 
ing appropriations  to  "  such  universities,  colleges,  or  other  suitable 
institutions  as  in  the  judgment  of  the  board  are  qualified  for  scientific 
research  for  the  purpose  of  discovering,  in  accordance  with  the  rules 
and  regulations  prescribed  hj  the  Interdepartmental  Social  Hygiene 
Board,  more  effective  medical  measures  in  the  treatment  and  preven- 
tion of  venereal  diseases." 

4.  Selecting  by  correspondence  and  making  appropriations  to  "  such 
colleges,  universities,  and  other  suitable  institutions  or  organizations 
as  in  the  judgment  of  the  Interdepartmental  Social  Hygiene  Board 
are  qualified  for  scientific  research  for  the  purpose  of  discovering 
and  developing,  in  accordance  with  the  rules  and  regulations  pre- 
scribed by  the  Interdepartmental  Social  Hygiene  Board,  more  effec- 
tive educational  measures  in  the  prevention  of  venereal  diseases  and 
for  the  purpose  of  sociological  and  psychological  research  related 
thereto." 

5.  Making  the  most  effective  use  of  the  limited  resource  secured 
from  the  national  security  and  defense  fund  for  the  maintenance  of 
the  board  during  this  period  of  administrative  financial  difficulty. 

On  April  1,  1919,  the  War  Department  assigned  to  the  board  the 
major  part  of  its  administrative  personnel,  which  had  prior  to  that 
date  been  attached  to  the  commission  on  training-camp  activities,  and 
known  as  its  law-enforcement  division.  It  was  at  this  time  that  the 
commission  on  training-camp  activities  was  very  largely  demobilized. 
The  field  service  for  some  months  prior  to  this  time  had  been  per- 
formed by  employees  of  the  board,  so  that  it  was  wholly  logical  to 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL.  HYGIENE  BOARD.      171 

transfer  the  administrative  personnel  of  the  law-enforcement  divi- 
sion to  the  Interdepartmental  Social  Hygiene  Board  at  this  time. 

Under  these  conditions  the  organization  of  the  board  during  this 
period  was  partly  made  up  of  personnel  receiving  compensation  from 
the  board  and  partly  of  personnel  assigned  to  the  Ijoard  from  the 
War  Department. 

This  central  administrative  organization  was  as  follows : 

PJxecutive  secretary,  Dr.  T.  A.  Storey. 

Assistant  director  of  the  medical  research  fund,  Dr.  R.  W.  Hoffman. 

Supervising  assistant  in  charge  of  men  in  the  field  service,  C.  1^. 
JViiner. 

Supervising  assistant  in  charge  of  women  in  the  field  service,  Miss 
Henrietta  Additon. 

Specialist  in  reformatories,  Mrs.  Martha  P.  Falconer. 

Assistant  specialist  in  reformatories,  Dr.  Mary  B.  Harris. 

Disbursing  agent,  R.  H.  Lovett. 

Clerks  and  stenographers. 

ACTIVITIES. 

1.  Civilian  Quarantine  and  Isolation  Fund. 

Under  the  provisions  of  the  act  creating  the  Interdepartmental 
Social  Hygiene  Board,  the  Secretary  of  War  and  the  Secretary  of 
the  Navy  are  authorized  and  directed  to  adopt  measures  to  assist  the 
various  States  "  in  caring  for  civilian  persons  whose  detention,  iso- 
lation, quarantine,  or  commitment  to  institutions  may  be  found  neces- 
sary for  the  protection  of  the  military  and  naval  forces  of  the  United 
States  against  venereal  diseases."  The  statute  set  aside  $1,000,000 
for  the  purpose  of  carrying  out  this  provision,  which  the  board  called 
"  the  civilian  quarantine  and  isolation  fund." 

PROGRAM    for   ASSISTANCE    OF    STATES    IN    BUILDING    REFORM AT<1RIES. 

The  Secretary  of  War  and  the  Secretary  of  the  Xavy  adopted  the 
program  proposed  before  the  subcommittee  of  the  Senate  Committee 
on  Military  Affairs  at  the  hearing  June  18,  1918,  and  authorized  the 
interdepartmental  Social  Hygiene  Board,  of  which  the  Secretaries 
are  active  memljers,  to  administer  this  fund  in  harmony  with  that 
program. 

In  conformity  with  this  program  an  agent  of  the  commission  on 
training-camp  activities  was  sent  out  into  the  States  for  the  purpose 
of  assisting  the  officials  and  public-spirited  citizens  to  secure  financial 
resources  with  which  to  build  detention  houses  and  reformatories  for 
women  over  the  age  of  18  years  and  for  girls  18  years  old  and  under, 
and  in  certain  States  for  colored  women  and  ffirls. 


172      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

i  he  work  of  establishing  throughout  the  country  reformatories  for 
women  and  girls,  detention  houses  and  detention  hospitals,  and  re-_ 
organizing  those  which  already  existed  to  meet  the  sudden  strain  put 
upon  them  by  war  conditions,  had  been  begun  under  the  War  De- 
partment in  April,  1918.  It  developed  out  of  the  efforts  made  to  effect 
a  law-enforcement  program  suppressing  vice  and  liquor  about  the 
military  training  camps.  Its  work  was  preceded  and  to  some  extent 
defined  by  the  popularization  of  the  detention-house  idea — the  value 
of  a  clearing  house  where  all  women  and  girls  (except  hardened 
cases)  who  are  arrested  may  be  held  while  awaiting  trial,  to  be  studied 
and  treated  medically.  The  committee  on  protective  work  for  girls, 
the  first  Federal  organization  to  engage  in  work  for  girls  in  the  war 
situation,  saw  the  great  need  of  the  detention  houses  in  the  camp  towns 
and  succeeded  in  popularizing  the  idea. 

Then,  in  Februaiy,  1918,  in  the  enforcement  of  section  13  of  the 
act  of  Congress  "to  authorize  the  President  to  increase  temporarily 
the  Military  Establishment  of  the  United  States,"  which  provided  for 
a  penalty  of  $1,000  fine  or  one  year's  imprisonment  for  conviction 
in  Federal  court  of  prostituting  within  the  5 -mile  zone  established 
about  military  camps,  19  girls  were  sentenced  from  South  Carolina 
to  the  National  Training  School  for  Girls  in  the  District  of  Columbia, 
because  the  State  of  South  Carolina  had  no  provisions  for  their  care. 
With  this  action  the  Federal  Government  experienced  the  need  of  ad- 
ditional facilities  for  the  custody  and  rehabilitation  of  girls  and 
women  found  to  be  a  menace  to  the  health  and  morals  of  the  men 
in  training.  The  19  girls  from  South  Carolina  arrived  in  Washington 
to  find  the  national  training  school  filled  to  capacity.  These  girls 
were  finally  placed  in  the  excellent  care  of  the  Massachusetts  Re- 
formatory for  Women  at  Framingham,  Mass. 

The  difficulty  of  their  disposal,  however,  centered  the  attention 
of  those  in  authority  in  the  War  Department  on  the  lack  of  institu- 
tional facilities  for  the  handling  of  the  camp-girl  problem.  As  a 
result,  late  in  February,  President  Wilson  set  aside  from  his  national 
security  and  defense  fund  the  amount  of  $250,000  for  the  establish- 
ment of  additional  facilities  for  the  custody  and  rehabilitation  of 
girls  and  women  who  proved  to  be  a  menace  to  the  health  and  morals 
of  the  men  in  training.  The  expenditure  of  this  money  became  the 
work  of  the  section  on  reformatories  and  detention  houses  of  the  com- 
mission on  training-camp  activities.  The  reorganization  of  certain 
already  existing  institutional  facilities  was  early  included  in  the  scope 
of  the  section's  work. 

The  director  began  her  work  April  8,  1918.  The  section  was 
organized  as  a  brancli  of  the  law-enforcement  division  of  the  com- 
mission on  training-camp  activities  and  Avas  coordinated  Avith  the 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      178 

section  on  women  and  girls  and  the  section  on  vice  and  liquor  con- 
trol. 

Various  plans  were,  of  course,  offered  for  the  work.  One  was  to 
build  four  human  reclamation  institutions  in  the  eastern,  southern, 
western,  and  northern  parts  of  the  United  States,  to  which  all  prosti- 
tutes, convicted  in  the  Federal  courts,  could  be  sent  for  the  period  of 
the  war.  At  first  consideration  that  plan  seems  to  deal  with  the 
whole  proposition  in  a  summarily  satisfactory  way.  But  practical 
difficulties  of  execution  were  paramount :  How  was  commitment  to  be 
secured,  and  how  did  such  procedure  develop  our  program  for  the 
immediate  care  of  delinquent  women  and  girls,  the  opportunity  for 
which  development  seemed  so  great  in  the  Federal  undertaking  ? 

Most  important  for  the  elimination  of  prostitution  seeined  to  be 
the  further  development  of  suitable  places  for  long-term  commit- 
ment for  women  and  girls.  Those  who  have  plied  this  trade  for 
months  and  5^ears  can  not,  without  general  rehabilitation  and  train- 
ing, become  economically  valuable  in  legitimate  work  as  the  result  of 
an  edict  or  a  short-term  sentence  to  idleness. 

On  the  other  hand,  not  all  women  convicted  of  prostitution  need  a 
long-term  sentence,  and  the  representatives  of  the  other  two  sections 
of  the  law-enforcement  division  were  appealing  for  suitable  places 
in  which  to  hold  the  women,  to  be  studied  and  treated  medically 
while  awaiting  trial  and  for  hospitalization  facilities  where  the 
women  could  be  medically  treated.  There  was  the  difficulty  also  that 
the  establishment  of  a  place  of  long-term  commitment  would  be  in 
some  States  impracticable,  as  there  was  no  law  providing  for  the 
holding  of  women  on  a  Jong-term  sentence. 

Consideration  of  all  these  conflicting  claims  for  immediate  action 
made  it  appai  ent  that  for  many  reasons  the  section  could  not  hope  to 
develop  an  identical  model  program  for  each  camp  community. 
Such,  in  general,  would  probably  have  included  a  detention  or  clear- 
ing house,  isolation  hospital  facilities,  and  a  State  industrial  farm 
as  a  place  of  long-term  commitment  with  facilities  for  separating 
young  girls  from  older  offenders.  Funds  were  insufficient  for  this, 
and  many  communities  could  not  support  the  undertaking.  It  was 
apparent  that  the  needs  of  each  camp  city  would  have  to  be  consid- 
ered separately,  though  in  the  reorganization  and  development  of  all 
the  institutional  facilities  there  were,  of  course,  general  principles 
to  be  laid  down.  There  were  the  management  of  all  institutions  for 
women  by  women,  the  location  of  all  places  of  long-term  commitment 
in  the  country,  the  provision  of  adequate  medical  facilities  for  the 
treatment  of  venereal  disease,  and  the  supervision  of  all  institutions 
Federally  aided  by  a  local  board  of  managers  composed  of  both  men 
and  women. 


174      REPORT  U.'S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

The  agents  sent  out  to  the  States  in  accordance  with  the  plan  of 
the  Interdepartmental  Social  Hygiene  Board  in  administering  its 
civilian  quarantine  and  isolation  fund  reported  that  there  were  on 
November  1,  1918,  only  34  States  with  reformatories  for  girls  and 
only  8  States  with  reformatories  for  women.  There  were  14  States 
with  1  reformatory  for  either  girls  or  women,  and  only  1  of  the 
Southern  States  that  had  a  reformatory  for  colored  girls.  No  South- 
ern State  had  a  reformatory  for  colored  women  over  18.  Obviously 
there  was  a  big  field  and  the  board  immediately  adopted  the  policy, 
as  already  indicated,  of  meeting  the  problem  by  aiding  the  States 
in  the  construction  of  reformatories.  It  was  definitely  decided  by 
the  board  to  extend  the  Federal  aid  in  this  way  and  not  in  any  case 
to  make  appropriations  which  would  be  used  in  maintaining  inmates 
of  the  institutions  assisted. 

On  November  26,  1918,  however,  came  the  decision  from  the  Comp- 
troller of  the  Treasury  informing  the  board  that  it  had  no  authority 
to  make  appropriations  for  the  construction,  enlargement,  or  repair 
of  buildings  that  are  not  Government  property.  As  a  result  of  this 
decision,  the  jDlans  of  the  board  for  assisting  States  to  build  deten- 
tion houses  and  reformatories  had  to  be  given  up  immediately  and 
it  was  impossible  for  the  Government  to  fulfill  certain  promises  given 
in  good  faith  of  money  from  the  appropriation  voted  in  the  Cham- 
berlain-Kahn  Act. 

At  that  time  application  had  come  in  from  nine  States  requesting 
in  total  an  appropriation  of  $257,000,  to  balance  which  a  considerably 
greater  amount  had  been  contributed  in  total  by  these  States.  The 
contributions  by  these  several  States  involved  appropriations  from 
the  Government  as  follows,  each  State  having  raised  an  amount 
equivalent  to  or  greater  than  the  amount  requested  from  the  Govern- 
ment : 

Alabama - $25, 000 

Arkansas 50,000 

Florida 5, 000 

Kentucky 30,  000 

Michigan 28,000 

North  Carolina 25, 000 

Pennsylvania 50,000 

South  Carolina 10,000 

Virginia--.. 34,000 

•  PROGRAM  FOR  ASSISTANCE  OF  STATES  IN  MAINTAINING  VENEREAL  DISEASE 

PATIENTS. 

Acting  on  the  decision  of  the  Comptroller  of  the  Treasury,  the 
Secretary  of  War  and  the  Secretary  of  the  Navy  authorized  the 
Interdepartmental  Social  Hygiene  Board  to  organize  plans  in  Decem- 
ber, 1918,  for  the  assistance  of  States  in  the  maintenance,  subsistence, 
and  treatment  of  civilian  persons  with  venereal  diseases  who  were  a 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     175 

menace  to  the  safety  of  the  armed  forces  of  the  United  States.  The 
settled  policy  previously  adopted  of  not  giving  assistance  for  such 
purposes  was  necessarily  abandoned,  as  it  now  appeared  that  this 
measure  was  one  of  the  few  which  would  comply  with  the  wording 
of  the  law. 

Between  December,  1918,  and  June,  1919,  inclusive,  the  board,  act- 
ing for  the  Secretary  of  War  and  the  Secretary  of  the  Navy,  gave 
assistance  in  the  following-named  amounts  for  the  maintenance  of 
venereally  diseased  patients 

Alabama  State  Training  Scliool  for  Girls,  Birmingham,  Ala $1,004.21 

Chattanooga  Detention  House  and  Hospital,  Chattanooga,  Tenn 5,  237.  64 

Dorcas  Home,  Houston,  Tex 1,656.95 

Jefferson  County  Institutions,  Louisville,  Ky 11,  247.  50 

Fairmount  Hospital,  Kalamazoo,  Mich 3,  921.  42 

Female  Detention  Ward,  St.  Louis  City  Hospital,  St.  Louis,  Mo 2,  387.  79 

Detention  Home  and  Hospital,  Lawton,  Okla 3,  326.  98 

Pine  Bluff  School,  Louisville,  Ky 276. 17 

Industrial  School  for  Colored  Girls,  Columbia,  S.  C 926. 19 

Mission  Valley  Isolation  Hospital,  San  Diego,  Calif 5,  691.  01 

State  Home  and  Industrial  School  for  Girls  and  Women,  Samarcand, 

N.    C 9,  486.  64 

Detention  Home  and  Hospital  (Carolyn  House),  Spartanburg,  S.  C—     1,403.78 

Kansas  State  Industrial  Farm  for  Women,  Topeka,  Kans 11,  631.  23 

Ward  L,  San  Francisco  Hospital,  San  Francisco,  Calif 3, 812. 16 

Lake  County  General  Hospital,  Waukegan,  111 205.  95 

Akron  Welfare  Home  for  Women,  Akron,  Ohio 1, 154.  36 

Girls'  Training  School,  Gainesville,  Tex 3,000.00 

Total 66,  360.  98 

Reports  from  the  institutions  listed  above  indicated  that  the  aver- 
age number  of  venereally  infected  persons  cared  for  in  those  institu- 
tions for  one  month  is  2,186.  The  actual  number  of  days'  treatment 
given  by  all  of  the  institutions  is  64,462.  This  figure  is  arrived  at  by 
multiplying  the  number  of  venereal  disease  patients  by  the  number  of 
days  of  treatment  each  received.  From  the  figures  thus  secured  it  is 
interesting  to  learn  that  the  cost  to  the  Federal  Government  for  mak- 
ing possible  these  64,462  days'  treatments  and  removing  from  the 
communities  a  monthly  average  of  2,186  sources  of  danger  to  the 
armed  forces  of  the  United  States  amounted  to  $1.03  per  person  per 
day.  (See  Appendix  B2  for  application  form  for  appropriation  for 
aid  in  maintenance  of  venereal  patients.) 

PROGRAM  or  PROTECTIVE  SOCIAL  MEASURES. 

Service  of  women  agents. 

In  September,  1917,  the  commission  on  training-camp  activities 
extended  its  functions  to  include  work  with  young  women  and  girls 
in  the  vicinities  of  training  camps  or  in  cities  frequented  by  large 


176     REPORT  TJ.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

numbers  of  soldiers  and  sailors.  A  committee  on  protective  work  for 
girls  was  formed  with  the  purpose  originally  of  throwing  such  safe- 
guards around  young  girls  as  would  prevent  later  delinquency. 
After  several  months  of  purely  protective  work  it  was  found  that  the 
women  and  girls  who  were  already  sex  offenders  presented  a  serious 
problem  in  the  camp  cities.  On  May  1,  1918,  the  policy  and  name 
were  changed  and  the  committee  was  reorganized  as  the  section  on 
women  and  girls  of  the  law-enforcement  division  of  the  commission, 
to.  concentrate  thereafter  on  work  with  delinquent  women  and  girls. 

At  the  time  this  organization  was  effected  60  protective  officers  had 
been  appointed.  In  some  cases  the  city  set  aside  an  appropriation  to 
start  the  work ;  in  others,  the  money  was  raised  by  the  local  commit- 
tee on  protective  work.  The  war  camp  community  service  and  the 
State  councils  of  defense  also  helped  to  support  the  work  in  some  in- 
stances. 

Under  the  new  organization  the  work  was  rapidly  extended*  The 
policies  of  the  director  of  the  section  were  executed  in  the  field  through 
district  supervisors  working  through  local  workers  called  fixed  post 
representatives,  stationed  where  the  presence  of  camps  or  training 
areas  created  a  need. 

In  further  conformity  with  the  plan  outlined  before  the  Senate 
committee  in  June,  1918,  the  Interdepartmental  Social  Hygiene 
Board  was  authorized,  toward  the  end  of  the  year,  to  take  over  a  por- 
tion of  the  field  service  of  the  law  enforcement  division  of  the  com- 
mission on  training  camp  activities.  The  transfer  was  effected  in  De- 
cember, the  field  staff  transferred  consisting  of  9  district  supervisors 
and  49  fixed  post  representatives.  Having  no  central  administrative 
resources,  the  board  could  not  take  over  at  this  time  the  administra- 
tion of  this  field  service. 

On  April  1,  1919,  however,  the  administrative  staff  of  the  section 
on  women  and  girls  was  detailed  to  the  Interdepartmental  Social 
Hygiene  Board,  and  the  direction  of  the  women  on  the  field  staff 
was  carried  on  for  the  executive  secretary  of  the  board  by  the  execu- 
tive assistant  in  charge  of  the  women's  work. 

On  May  15  there  were  8  district  supervisors  and  106  special  agents. 
This  had  been  reduced  by  July  1  to  8  supervisors  and  55  special 
agents.     These  agents  were  stationed  in  the  following  cities : 

Allentown,   Pa.  Chicago,  111. 

American  Lake,  Wash.  Chillicothe,  Ohio. 

Atlanta,  Ga.  Columbus,  Ohio. 

Augusta,  Ga.  Des  Moines,  Iowa. 

Baltimore,  Md.  East  St.  Louis,  111. 

Battle  Creek,  Mich.  El  Paso,  Tex. 

Boston,  Mass.  Englewood,  N.  J. 

Brooklyn,  N.  Y.  Hattiesburg,  Miss. 

Chattanooga,  Tenn.  Hempstead,  Long  Island. 


REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD.     177 

Junction  City,  Kans.  Piiiladelphia,  Pa. 

Jersey  City,  N.  J.  Pittsburgh,  Pa. 

Lawton,  Olila.  Portsmouth,  Va. 

Little  Rock,  Arls.  Roclfford,  111, 

Louisville,  Ky.  San  Antonio,  Tex. 

Manhattan,  Kans.  .  San  Francisco,  Calif. 

Mobile,  Ala.  Seattle,  Wash. 

Mount  Holly,  N.  J.  Spartanburg,  S.  C. 

New  Brunswick,  N.  J.  St.  Louis,  Mo. 

Newport  News,  Va.  Trenton,  N.  J. 

Norfolk,  Va.  Waukegan,  111. 

Patchogue,  Long  Island.  Wilmington,  Del. 

In  the  following  cities  local  workers  paid  by  private  individuals  or 
organizations,  or  by  city  or  county  funds,  were  working  also  under 
the  direction  of  this  section : 

Alexandria,  La.  Lowell.  Mass. 

Birmingham,  Ala.  Lynn,  Mass. 

Bremerton,  Wash.  Memphis,  Tenn. 

Cambridge,  Mass.  Newburgh,  N.  Y. 

Chester,  Pa.  New  Orleans,  La. 

Cincinnati,  Ohio.  New  York  City. 

Cleveland,  Ohio.  Petersburg,  Va. 

Dayton,  Ohio.  Portland,  Oreg. 

Detroit,  Mich.  Princeton,  N.  J. 

Erie,  Pa.  Puget  Sound,  Wash. 

Fort  Worth,  Tex.  San  Diego,  Calif. 

Greenville,  S.  C.  Tacoma,  Wash. 

Highlands,  N.  J.  ,  Vancouver,  Wash. 

Houston,  Tex. 

The  primary  purpose  of  this  work  is  the  protection  of  soldiers  and 
sailors  through  the  control  of  vice  and  venereal  disease,  both  by  per- 
sonal work  with  individual  cases  and  by  direct  attack  on  specific  con- 
ditions in  communities  where  this  work  is  carried  on. 

Individual  ca^e  work  has  been  in  a  sense  the  laboratory  work  of  the 
social  hygiene  campaign.  Approximately  30,000  women  and  girls 
have  been  helped  in  various  ways  by  our  own  field  staff,  although 
intensive  work  was  done  on  only  7,600  cases  of  delinquency.  Many 
of  these  girls  have  been  arrested.  The  representatives  of  the  board 
investigated  these  cases  and  were  able  to  give  the  judge  in  each  case 
information  so  that  he  could  base  his  decisions  on  the  particular 
needs  of  each.  The  keynote  of  this  individual  work  has  been  to  show 
the  girl  a  way  out  of  the  life  she  has  been  leading.  In  some  cases  she 
was  returned  to  her  family;  in  others  a  congenial  occupation  was 
found  for  her,  or  it  was  made  possible  for  her  to  get  additional  edu- 
cation or  a  special  kind  of  training. 

All  delinquent  girls  have  been  given  a  physical  examination  when 
possible;  if  infected  with  venereal  disease  they  have  been  taken  to 
United  States  Public  Health  Service  or  other  available  clinics  or  hos- 
pitals for  treatment.  In  some  cases  it  has  been  necessary  to  recom- 
15610—20 12 


178      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

mend  that  the  girls  be  Goirmiitted  to  an  institution,  and  at  such  times 
every  effort  has  been  made  to  see  that  they  are  sent  to  real  reforma- 
tories where  there  is  provision  for  education  and  training  and  where 
they  will  be  kept  long  enough  to  effect  a  change  in  their  lives. 

The  fact  that  the  cases  dealt  with  represent,  delinquent  women  and 
girls  from  every  part  of  the  country  has  enabled  the  board  to  prepare 
the  first  national  study  of  delinquency.  This  study  shows  that  in 
general  the  girls  have  come  from  poor  homes  and  have  had  limited 
opportunities.  They  are  poorly  educated  and  started  to  work  early  at 
unskilled  labor.  Such  a  study  shows  community  needs.  It  has  been 
found  in  certain  localities  that  as  many  as  25.4  per  cent  of  the  de- 
linquent group  never  attended  school  and  33.2  per  cent  left  before  the 
age  of  14.  Such  a  condition  shows  the  need  of  added  legislation  and 
better  law  enforcement.  Without  this  combination  of  individual 
study,  and  through  it  recognition  of  community  needs,  no  worker 
can  hope  to  accomplish  the  full  readjustment  of  the  misfit  delinquent 
and  thus  shut  off  one  large  source  of  venereal  disease. 

It  is  impossible  to  show  with  statistics  the  effect  that  the  field  staff 
has  had  on  the  moral  tone  of  the  places  where  they  have  been  sta- 
tioned. They  have  sought  to  develop  community  responsibility 
through  local  committees.  These  committees  have  been  shown  by 
local  cases  the  need  for  adequate  facilities  for  the  care  of  delinquents 
and  the  physically  and  mentally  unfit,  and  have  been  made  to  realize 
that  it  is  easy  to  make  delinquents  of  girls  who  live  in  dark,  dirty 
homes  and  work  at  tasks  which  are  uninteresting  and  poorly  paid. 

In  the  work  with  individual  cases  the  board's  special  agents  have 
found  certain  instances  where  public  officials,  judges,  police,  and 
health  authorities  have  used  improper  and  inadequate  methods.  De- 
tails of  such  cases  have  been  given  to  the  male  representatives  of 
the  board,  who  have  brought  them  to  the  attention  of  the  responsible 
ofiicials.  Where  no  improvement  was  shown,  the  influence  of  the 
local  committee  was  often  brought  to  bear  with  good  results. 

The  board's  workers  have  made  every  effort  to  see  that  suitable 
institutions,  reformatories,  detention  homes,  hospitals,  and  institu- 
tions for  the  feeble-minded  were  provided  and  that  the  women  of 
the  community  were  acquainted  with  the  conditions  in  all  institu- 
tions for  women  and  girls.  They  assisted  in  maintaining  wholesome 
standards  in  dance  halls,  moving  picture  and  burlesque  theaters, 
parks,  and  similar  places  of  amusement.  In  many  places  dance-hall 
managers  have  been  persuaded  to  engage  satisfactory  chaperons. 
Better  lighting  and  policing  of  parks  has  also  been  secured. 

This  first-hand  information  which  has  been  spread  through  the 
committees  cannot  fail  to  do  much  toward  lessening  the  venereal 
disease  rate  by  securing  the  social  legislation  necessary  in  suppressing 
commercialized  vice  and  the  exploitation  of  children  in  industry, 
and  in  promoting  proper  public  recreation  and  vocational  education. 


REPOET  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD.     179 


While  the  result  of  this  work  may  seem  intangible,  it  has  been 
sufficiently  concrete  and  resultful  in  the  local  communities  to  inspire 
confidence  and  to  secure  local  financial  support  aggregating  over 
$500,000  from  May  1,  1918  to  May  1,  1919. 

PKOORAM   OF  PROTECTIVE  SOCIAT,  ^MKAST'RKS. 

Service  of  men  agents. 

On  April  1,  1919,  the  board  took  over  practically  all  of  the  field 
personnel  of  what  had  been  known  up  until  that  date  as  the  section 
on  vice  and  liquor  control  of  the  War  Department  Commission  on 
Training  Camp  Activities,  together  with  a  limited  number  of  per- 
sons to  constitute!  a  headquarters  staff.  The  field  personnel,  composed 
almost  entirely  of  Army  officers  who  requested  their  discharge  from 
the  service  in  order  to  accept  appointment  with  the  board,  totaled  50, 
including  13  persons  (9  men  and  4  women)  whose  activities  were 
limited  to  the  securing  of  accurate  information  as  to  the  existence  of 
conditions  that  were  a  menace  to  soldiers  and  sailors  through  the 
possibility  of  spread  of  venereal  disease.  The  headquarters  staff 
consisted  of  one  executive,  and  in  addition  a  limited  stenographic 
staff  provided  by  the  War  Department  Commission  on  Training 
Camp  Activities. 

This  staff  was  gradually  reduced  coincident  with  the  demobiliza- 
tion of  the  Army  and  Navy  until  on  June  30  the  field  staff  consisted 
of  32  persons,  including  11  whose  duties  were  limited  to  the  securing 
of  accurate  information.  The  following  list  indicates  the  location 
of  these  agents  on  June  30  and  the  territory  covered : 

Location  of  agents. 


Location. 


Number. 


Territory. 


Augusta,  Ga 

Baltimore,  Md 

Battle  Creek,  Mich. . 
Boston,  Mass 

Chicago,  111 

Denver,  Colo 

Detroit ,  Mich 

Kansas  City,  Mo 

Lancaster,  Pa 

Little  Rock,  Ark 

Louisville,  Ky 

Minneapolis,  Minn. 

Newark,  N.  J 

New  London,  Conn. 
New  Orleans,  La 

Newport  News,  Va. 
New  York  City 

Petersburg,  Va 

Portsmouth ,  N.  H . , 
San  Antonio,  Tex. . 

San  Francisco,  Calif 
Washington,  D.  C. 
Worcester ,  Mass 


Georgia. 

Maryland,  Virginia,  Pennsylvania,  Delav.are,  Dis- 
trict of  Columbia. 

Michigan. 

Massachusetts,  New  Hampshire,  Vermont,  New 
York,  Rhode  Island ,  Connecticut ,  Maine. 

Wisconsin,  Illinois,  Indiana,  Ohio,  Michigan. 

Colorado,  Wyoming,  Utah,  Montana. 

Michigan,  Ohio. 

Kansas,  Missouri. 

Delaware,  Pemisylvauia. 

Arkansas. 

Indiana,  Ohio,  Kentucky,  Illinois,  Missouri. 

Minnesota. 

New  Jersey ,  New  York,  Pennsylvania. 

Connecticut. 

Alabama,  Arkansas,  Florida,  Georgia,  Illinois,  In- 
diana, Iowa,  Kentucky,  Louisiana,  Michigan, 
Minnesota,  North  Carolina,  Ohio,  Missouri,  South 
Carolina,  Virginia,  District  of  Columbia,  Wiscon- 
sin, Mississippi,  Tennessee. 

Virginia. 

New  York,  Coimecticut,  Delaware,  District  of  Co- 
lumbia ,  Kentucky ,  Ind  iana ,  Michigan ,  New  Jersey , 
Pennsylvania,  Maryland,  Ohio,  Virginia,  West 
Virginia,  Wisconsin,  Illinois. 

Virginia. 

Maine,  Massachusetts, New  Hampshire. 

Arizona,  Arkansas,  Louisiana,  New  Mexico,  Okla- 
homa, Texas. 

California. 

West  \'irginia,  Pennsylvania,  Maryland. 

Connecticut,  Massachusetts,  Rhode  Island. 


180      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

These  agents,  together  with  the  larger  group  of  women  previously 
taken  over  by  the  board,  and  several  persons  formerly  composing 
the  section  on  reformatories  and  detention  homes  of  the  War  Depart- 
ment Commission  on  Training  Camp  Activities,  were  then  com- 
bined into  a  single  organization  known  as  the  field  service  of  the 
United  States  Interdepartmental  Social  Hygiene  Board. 

The  members  of  this  service  were  stationed  at  important  military 
and  naval  posts  throughout  the  country ;  the  women  representatives 
largely  on  fixed  posts  or  spending  a  major  portion  of  their  time  at 
one  place;  the  men,  for  the  most  part,  moving  from  place  to  place 
and  ha\dng  duties  in  relation  to  several  military  and  naval  places, 
although  at  stations  of  decided  importance  both  male  and  female 
agents  were  assigned  to  continuous  duty. 

These  agents,  functioning  under  the  provisions  of  section  2,  of 
Chapter  XV,  of  the  Chamberlain-Kahn  Act  concerned  themselves 
with  activities  in  accordance  with  a  program  which  was  announced 
for  the  field  service  of  the  board,  men  and  women,  as  follows : 

I.  General  objective. — Because  of  the  provisions  of  section  2,  Chapter  XV, 
the  field  service  of  tlie  United  States  Interdepartmental  Social  Hygiene  Board 
may  very  properly  continue  all  of  the  activities  that  have  been  developed 
under  the  law-enforcement  division  of  the  commission  on  training-camp  activi- 
ties that  are  concerned  with  "  assisting  the  various  States  in  caring  for  civilian 
persons  whose  detention,  isolation,  quarantine,  or  commitment  to  institutions 
may  be  found  necessary  for  the  protection  of  the  military  and  naval  forces  of 
the  United  States  against  venereal  diseases." 

The  field  agent  ghould  inform  himself  concerning: 

(1)  Places  of  amusement,  recreation,  loitering,  loafing,  dance  halls,  parks, 
movies,  theaters,  streets,  hotel  lobbies,  military  and  naval  camp  neighborhoods 
in  which  carriers  of  venereal  disease  are  likely  to  be  found. 

(2)  Hotels,  houses  of  ill  repute,  and  other  places  in  which  venereal  disease 
carriers  may  transmit  disease, 

(3)  Courts,  judges,  police,  special  civic  committees,  boards  of  health  (city, 
county,  and  State),  agents  of  United  States  Public  Health  Service,  morale  offi- 
cers, and  camp  committees  that  are  known  to  be  concerned  with  the  care  of 
venereal  disease  carriers. 

(4)  Detention  houses,  clinics,  hospitals,  jails,  reformatories,  homes,  farmSi 
and  reform  schools  in  which  venereal  disease  carriers  may  be  placed  for  treat- 
ment, restraint,  cure,  and  rehabilitation. 

(5)  Laws  and  ordinances  that  are  applicable. 

(6)  Associations,  societies,  clubs,  chambers  of  commerce,  boards  of  trade, 
women's  clubs,  labor  unions,  parent-teachers'  associations,  merchant's  associa- 
tions, and  other  similar  organizations  that  are  or  ought  to  be  concerned  with 
the  protection  of  the  military  and  naval  forces  against  the  carriers  of  venereal 
disease. 

II.  Assistance  in  connection  with  the  detention  of  disease  carriers. —  (a)  Gen- 
eral:  (1)  Inform  local  agencies  concerning  existing  community  conditions.  In- 
volves a  relationship  with  agencies  and  sometimes  involves  the  organization 
of  new  agencies;  (2)  inform  these  agencies  concerning  practical  laws  and  need 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      l8l 

for  new  laws  that  may  be  invoked  for  control  of  these  conditions;   (3)  coordi- 
nate existing  agencies;  (4)  establish  permanency  of  local  agencies. 

(&)  Special:  (1)  Identify  carriers  (men  and  women)  in  dance  halls,  parks, 
etc.;  (2)  get  into  contact  with  individual  agents  of  the  law  or  other  authorized 
local  social  service  agencies  and  assist  in  detec-tion  and  identilication  for  de- 
tent on  ;  (3)  assist  in  securing  examinaticm  for  diagnosis,  not  only  with  refer- 
ence to  disease  but  also  for  delinquency  iuul  for  the  possibility  of  restoration  or 
rehabilitation;  (4)  inform  the  individual  woman  or  girl,  boy  or  man. 

III.  Assistance  in  connection  with  isolation,  quarantine,  and  commitment. — 
(a)  General:  (1)  Inform  local  agencies  concerning  available  institutions  for 
these  purposes.  Emphasize  importance  of  detention  hospitals,  clinics,  hospitals, 
and  suitable  jails  and  reformatories;  need  for  age  discrimination;  color  dis- 
crimination; degree  of  delinquency;  sex.  (2)  Work  for  the  permanency  of 
wise  institutional  care. 

(b)  Special:  (1)  Investigate  individual  institutions  and  assist  in  securing 
better  care,  repair,  restoration,  and  enlargement;  and  treatment  and  employ- 
ment of  inmates;  their  hygienic  information  and  advice  and  a  wisely  ordered 
day's  program.  (2)  Help  in  standardizing  for  the  better  care  of  venereal 
cases  in  these  institutions. 

IV.  Assistance  through  the  orffanisation,  of  local  agencies,  or  through  their 
reorganization,  in  an  attempt  to  conserve  and  perpetuate  what  has  already  been 
done,  and  to  provide  for  local  self-support  and  independence  when  the  Govern- 
ment withdraws.  Type  of  organization  to  be  effected :  Locally,  a  law-enforce- 
ment committee,  made  up  of  influential  citizens  without  reference  to  political 
or  religious  views.  Committee  must  be  adequately  financed  locally.  Repre- 
sentatives should  consult  Washington  office  before  initiating  such  organization. 

V.  Assistance  through  cooperation  and  coordination. —  (1)  The  individual 
members  of  the  field  service  of  the  board  must  be  mutually  cooperative.  Team 
work  in  the  next  three  months  is  absolutely  essential  for  success.  (2)  It  is 
of  the  gi'eatest  importance  to  make  friends  and  establish  confidence  with  the 
various  agencies  in  the  field,  in  boards  of  health,  United  States  Public  Health 
Service,  clinic  officials,  hospital  officials,  police,  .judges,  prominent  civilians, 
<>tc.     (3)   Bring  these  agencies  into  a  cooperative  relationship  with  each  other, 

yi.  Develop  local  leaders. —  (1)  Provide  understudies  so  that  some  one  com- 
petent to  do  so  will  carry  on  your  work  when  you  are  through.  (2)  Habituate 
local  leaders  in  the  exercise  of  these  functions.  (3)  Develop  new  leaders — ■ 
safe,  informed,  and  in  good  standing.     (4)  Provide  for  financial  support. 

VII.  Organization  of  field  service. —  (1)  Until  further  order  the  local  field 
organization  will  continue  without  change  for  although  the  three  sections  of 
the  law  enforcement  division  C.  T.  C.  A.  are  merged  in  the  single  field  service 
of  the  Interdepartmental  Board,  the  present  director  of  reformatories  and 
houses  of  detention,  the  assistant  director  of  the  section  on  women  and  girls, 
and  a  supervisor  of  the  section  on  vice  and  liquor  control  will  be  retained  by 
the  executive  secretary  as  experts  in  their  respective  departments.  (2)  Each 
field  supervisor,  man  or  woman,  will  be  responsible  directly  to  the  executive 
secretajry.  (3)  Field  agents  will  continue  present  standard  form  of  reports, 
omitting  sections  on  liquor.  Case  reports  from  women  agents  will  continue. 
All  field  agents  will  send  reports  directly  to  the  Washington  office;  women  will 
continue  as  at  present  to  send  copies  of  reports  to  their  district  supervisor. 

Systematic  reports  were  required  of  field  agents.  During  th© 
period  from  April  1  to  June  30,  241  reports  were  made  by  special 


182      REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD. 

agents  on  their  activity  in  carrying  out  the  board's  program.     A 
summary  of  these  reports  is  presented  herewith  : 

Special  agents'  report. 

Number  of  States  in  which  investigation  were  made 30 

Number  of  cities  in  whicli  investigations  were  made 81 

Total  number  of  reports 241 

Number  of  reports  in  each  month : 

April 160 

May- 80 

June 95 

Total  number  of  persons  making  reports 30 

Total  number  of  reports  indicating  conditions : 

Good 119 

Fair 101 

Bad- - _, 21 

Total  number  of  places  in  which  conditions  changed  from — 

Good  to  fair 1 

Good  to  bad: ,0 

Fair   to   good 2 

Fair  to  bad . 1 

Bad  to  good 1 

Bad  to  fair 3 

Good  to  fair  to  good . 4 

Good  to  fair  to  good  to  fair .- ■ : 1 

Fair  to  good  to  fair  to  good 3 

Fair  to  good  to  fair  to  good  to  fair —  1 

Bad  to  fair  to  good 1 

18 

Total  number  of  places  in  which  conditions  did  not  change: 

Eemained  good 9 

Remained  fair 8 

Remained  bad 3 

20 

Total  number  of  places  for  which  only  one  report  was  received : 

Good .22 

Fair 18 

Bad - 3 

43 

The  words  "  good,"  "  fair,"  "  bad,"  relate  to  conditions  in  the  vari- 
ous cities  reported  on.  A  city  is  reported  "  bad  "  when  prostitution 
is  easily  accessible  to  soldiers,  where  the  officials  are  uncooperative, 
and  where  the  machinery  for  protecting  soldiers  and  sailors  from 
venereal  disease  is  either  inadequate  or  inefficient.  The  term  "  fair  " 
is  used  where  prostitution  is  available  to  a  limited  extent,  where  the 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD.     183 

city  officials  are  half-heartedly  functioning  under  pressure  or  because 
of  a  limited  conviction  and  where  either  the  machinery  for  protecting 
soldiers  and  sailors  from  venereal  disease  is  only  fairly  satisfactory 
in  its  equipment  and  operation.  Conditions  are  marked  "  good  "  on 
any  places  where  it  is  difficult  for  soldiers  or  sailors  to  find  prostitutes, 
where  the  officials  are  awake  and  active  and  where  the  cooperation 
between  officials  is  good  and  the  equipment  both  in  good  repair  and 
functioning  reasonably  well. 

In  addition  to  the  staff  of  special  agents,  a  staff  of  13  persons  (9 
men  and  4  women)  known  as  "  under-cover  investigators,"  was  avail- 
able during  the  year  commencing  July  1,  1918,  for  special  work. 
These  investigators  were  assigned  to  the  duty  of  securing  accurate 
information  as  to  the  violation  of  laws  against  prostitution ;  the  pres- 
ence of,  together  with  detailed  information  concerning  prostitutes, 
both  male  and  female;  and  in  general  to  furnish  the  central  office 
and  the  field  agent  with  accurate  information  on  which  a  judgment 
might  be  reached  as  to  the  effectiveness  of  the  program  for  the  pro- 
tection of  soldiers  and  sailors  from  venereal  disease.  It  is  evident 
that,  if  the  whole  program  functions  vigorously,  it  will  be  conse- 
quently difficult  for  an  under-cover  investigator  to  find  prostitutes. 
Probably  no  better  index  can  be  found  of  the  effective  functioning 
of  a  law  enforcement  program  than  the  information  presented  to 
the  under-cover  investigator  by  members  of  the  prostitute  class. 

During  the  three  months'  period  covered  by  this  report,  116  re- 
ports were  made  by  these  investigators  in  85  different  cities  and  25 
States.  Conditions  were  reported  "  excellent "  in  one  city,  "  good  " 
in  33,  "  fair  "  in  27,  "  bad  "  in  50,  and  "  very  bad  "  in  5. 

On  many  cities  only  one  report  was  made  during  this  period.  In 
cities  on  which  more  than  one  report  was  received  a  comparison  of 
conditions  was  possible.  This  comparison  shows  that  in  no  city  did 
conditions  become  worse  and  in  a  number  of  cities  they  became  better. 
The  under-cover  agents'  reports  indicate  that  up  to  June  30,  1919,  in 
spite  of  unsettled  conditions  incident  to  demobilization  and  the  gen- 
eral unsettled  state  of  affairs  following  the  signing  of  the  armistice 
and  the  turning  over  of  the  law  enforcement  program  from  the  mili- 
tary Commission  on  Training  Camp  Activities  to  the  civilian  Inter- 
departmental Board,  in  only  one  city  among  those  where  it  was  pos- 
sible to  make  a  comparison  was  there  evidence  that  the  program  for 
protecting  soldiers  and  sailors  from  venereal  disease  was  not  at  least 
maintaining  this  standard. 

2.  Scientific  Research  Fund. 

Another  large  activity  of  the  Interdepartmental  Board  imposed  by 
the  act  creating  it  is  covered  under  the  scientific  research  fund  of 
$100,000.    This  fund  is  to  "  be  paid  tO;  such  universities,  colleges,  or 


184      REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD. 

other  suitable  institutions  as  in  the  judgment  of  the  Interdepart- 
mental Social  Hygiene  Board  are  qualified  for  scientific  research,  for 
the  purpose  of  discovering,  in  acordance  with  rules  and  regulations 
prescribed  by  the  Interdepartmental  Social  Hygiene  Board,  more 
effective  medical  measures  in  the  prevention  and  treatment  of  vene- 
real disease,"  In  January,  1919,  the  board  adopted  the  rules  and 
regulations  to  cover  appropriations  from  this  fund  as  follows : 

1.  Appropriations  from  this  fund  will  be  made  only  to  universities,  colleges, 
or  other  suitable  institutions  that  give  satisfactory  evidence  of  possessing  a 
staff  of  scientific  experts  and  an  equipment  of  scientific  apparatus,  supplies,  and 
resources  that  will  guarantee  that  the  researches  undertaken  will  be  carried  out 
under  approved  scientific  conditions  and  in  conformity  with  scientific  methods. 

2.  Appropriations  for  this  fund  for  scientific  research  will  be  made  only  for 
definite  investigations  that  are  described  by  the  proposers  in  sufficient  detail  to 
satisfy  the  Interdepartmental  Social  Hygiene  Board  that  there  is  a  justifiable 
expectation  that  these  researches  "  will  discover  more  effective  medical  meas- 
ures in  the  prevention  and  treatment  of  venereal  diseases." 

3.  The  universities,  colleges,  or  other  institutions  proposing  researches  and 
asking  for  appropriations  will  furnish  information  on  the  following  subjects: 

(a)  Name  ot  institution  requesting  appropriation. 

(b)  Name,  office,  and  address  of  official  representative  of  this  institution. 

(c)  Title  concisely  descriptive  of  research  proposed. 

(d)  Laboratory  in  which  research  is  to  be  carried  out. 

(e)  List  of  more  important  scientific  publications  from  this  laboratory. 

if)  Name  and  concise  statement  of  the  scientific  training  of  the  laboratory 
chief  or  director  or  other  individual  responsible  for  the  scientific  policy  of  the 
laboratory. 

(fir)  Laboratory  staff,  giving  names,  degrees/  etc. 

(h)  Laboratory  equipment  and  facilities,  with  a  concise  statement  indicating 
scientific  and  working  capacity  of  the  laboratory,  and  cooperating  laboratories, 
departments,  and  agencies. 

(i)  Description  of  research  proposed;  outline  plan  in  sufficient  detail  to 
show  clearly  its  scientific  character  and  justify  the  expectation  that  it  will  dis- 
cover "more  effective  medical  measures  in  the  prevention  and  treatment  of 
venereal  diseases."  Include  references  to  important  scientific  investigators,  but 
n)ay  include  salaries  for  technical  assistants. 

(j)  Will  this  institution  be  able  to  carry  on  the  research  proposed  if  it  re- 
ceives no  financial  aid  from  the  Interdepartmental  Social  Hygiene  Board? 

4.  Universities,  colleges,  and  other  institutions  asking  for  appropriations  will 
furnish  the  board  with  a  budget  made  out  on  forms  supplied  by  the  board  and 
will  make  an  accounting  of  their  disbursements  in  conformity  with  the  rules  of 
the  Comptroller  of  the  Treasury  of  the  United  States  Government. 

(See  Appendix  E2  for  application  form  for  appropriation.) 
Up  to  June  30,  1919,  14  institutions  in  all  parts  of  the  country 
had  met  the  regulations  and  had  received  appropriations  for  27 
separate  scientific  investigations  from  the  Interdepartmental  Social 
Hygiene  Board.  The  total  of  the  appropriations  from  the  scientific 
research  fund  for  these  27  investigations  amounted  to  $97,670,  the 
range  of  appropriations  varying  from  $1,550  to  the  Woman's  Medical 
College  of  Pennsylvania  for  one  investigation  to  $19,050  to  Johns 
Hopkins  University  for  four  investigations. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     185 

A  glance  at  the  institutions  receiving  this  Federal  aid  will  show 
that  some  of  the  finest  scientific  laboratories  and  equipment  in  the 
country  were  set  to  work  on  special  phases  of  the  venereal  disease 
problem  as  a  result  of  the  appropriations  administered  by  the  Inter- 
departmental Social  Hygiene  Board.  By  the  same  token  some  of  the 
most  expert,  highly  trained,  and  best-known  scientific  investigators 
of  the  country  are  bringing  their  experienc^ed  and  trained  efforts  to 
bear  upon  the  venereal  disease  problem. 

The  investigations  under  way  cover  a  wide  range  of  subjects,  each 
one  of  very  great  importance  in  the  fight  on  venereal  diseases.  The 
table  following  shows  a  general  summary  of  the  appropriations  as  of 
June  30,  1919,  from  this  scientific  research  fund : 

Data  on  soientific  research  fund. 


Institution. 


Number 
ofinsti- 
tutions. 


Amount 
of  appro- 
priation. 


Number 

of  re- 
searches. 


Persons  engaged. 


Scientific 

investi- 
gators, 

technical 
and 

chemical 
assist- 
ants.! 


Clerks, 
stenog- 
raphers, 

and 
dieners.' 


Total. 


97,670 


University  of  Michigan 

Leland  Stanford  University 

Johns  Hopkins  Univ  ersity 

Cornell  University 

Uni  vorsity  of  Wisconsin 

University  of  Nebraska 

St.  Louis  University  School  of  Medicine 

Women's  Medical  College  of  Pennsylvania 

Washington  University  School  of  Medicine,  Missouri. 

Jefferson  Medical  Colle"  e 

Yale  University 

Union   University    Medical   Department,   Albany 

Medical  Colle  e 

Harvard  Uni ,  ersity 

University  of  Minnesota  Medical  School 


6,000 
7,200 

19,030 
7,440 
8,000 
5, 000 
3,000 
1,5£0 

13, 200 
2,500 
5,100 

4,380 
7,000 
8,250 


10 

1 

V 

IS 

7 

2 

1 

13 

2 

7 

2 

3 

1 

4 

S 

17 

2 

in 

9 

11 

1  Approximate  number;  also  includes  part-time  assistants. 

The  first  appropriation  from  this  fund  was  made  on  March  28, 
1918.  It  is,  of  course,  hardly  necessary  to  point  out  the  fact  that 
none  of  these  researches  was  completed  during  the  period  covered 
by  this  resume,  but  it  is  equally  evident  that  these  27  scientific  inves- 
tigations now  being  carried  out  by  a  group  of  men  and  women  con- 
taining some  of  the  most  competent  scientific  minds  in  America  must 
inevitably  achieve  real  progress  in  the  better  prevention  and  treat- 
ment of  gonorrhea,  syphilis,  and  chancroid.  It  is  particularly  grati- 
fying that  this  remarkable  series  of  scientific  researches  has  been 
stimulated  through  and  because  of  appropriations  specifically  set 
aside  for  these  general  purposes  by  Congress. 


186    report  u.  s.  iistterdepartmental,  social  hygiene  boaed. 

3.  Educational  Research   and   Development   Fund. 

For  the  purpose  of  discovering  and  developing  more  effective  edu- 
cational measures  in  the  prevention  of  venereal  disease,  Congress 
made  available  to  the  Interdepartmental  Social  Hygiene  Board  the 
sum  of  $300,000.    The  law  provided  that  this  money — 

shall  be  paid  to  such  universities,  colleges,  or  other  suitable  institution  or 
organization  as  in  the  judgment  of  the  Interdepartmental  Social  Hygiene  Board 
are  qualified  for  scientific  research  for  the  purpose  of  discovering  and  develop- 
ing in  accordance  with  the  rules  and  regulations  prescribed  by  the  Interdepart- 
mental Social  Hygiene  Board  more  effective  educational  measures  in  the  preven- 
tion of  venereal  disease,  and  for  the  purpose  of  sociological  and  psychological 
research  related  thereto. 

In  laying  out  its  plans  under  the  provisions  of  this  section  of  the 
act  the  board  has  concerned  itself  with  the  formulation  of  a  program 
that  would  lead  to  permanency  of  educational  influence  and  reach  the 
child  in  the  home  and  the  pupil  in  school. 

Relative  permanency  of  influence  is  secured  by  establishing  depart- 
ments of  hygiene  in  strong  normal  schools,  colleges,  and  universities. 
Wherever  such  a  department  has  been  created  or  has  been  more  firmly 
implanted  or  more  completely  organized  because  of  this  board,  the 
United  States  Government  may  be  said  to  have  achieved  thereby  a 
lasting  educational  influence  through  the  succeeding  generations 
added  yearly  to  the  graduate  body  of  the  educational  institution  con- 
cerned. 

The  normal  school,  college,  and  university  are  sources  from  which 
come  our  college  professors,  our  school  superintendents,  our  school 
principals,  and  our  secondary-school  teachers.  The  board  proposes 
that  these  teachers  of  teachers  and  these  teachers  of  children  shall 
be  as  well  prepared  in  the  elements  of  hygiene  as  they  are  in  the  ele- 
ments of  arithmetic  and  English.  Each  institution  that  successfully 
develops  its  department  of  hygiene  in  cooperation  with  the  board 
becomes  an  avenue  through  which  the  school  children  of  the  next 
generation  will  receive  better  and  more  complete  hygienic  instruction. 

Furthermore,  the  graduates  of  our  normal  schools,  colleges,  and 
universities  become  our  citizens  of  position  and  influence.  They  are 
directly  or  indirectly  teachers  in  the  community,  in  the  school,  and 
in  the  home.  In  training  these  students  for  graduation  our  institu- 
tions of  higher  learning  are  training  the  influential  parents  of  to- 
morrow. These  students  will  carry  into  their  own  homes  with  their 
problems  of  parenthood  the  education  and  the  information  that 
makes  an  impression  on  them  to-day. 

In  the  further  development  of  its  plans  the  board  is  convinced 
that  it  would  be  a  very  serious  mistake  to  support  a  program  of 
education  that  would  drag  the  hygiene  of  the  venereal  diseases  into 
the  academic  limelight  as  a  separate  and  distinct  entity  in  the  edu- 


EEPOET  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     187 

cational  curriculum.  The  board  is  of  the  opinion  that  it  will  meet 
its  obligations  under  the  law  much  more  effectively  and  that  its 
educational  procedure  will  be  much  more  rational  if  it  supports  a 
program  of  informational,  educational,  and  applied  hygiene  that 
insists  on  the  appropriate  inclusion  of  the  hygiene  of  gonorrhea, 
syphilis,  and  chancroid,  or  of  considerations  preliminary  thereto, 
giving  them  the  proportionate  emphasis  which  they  deserve  along 
with  other  important  subjects  in  hygiene. 

The  board  proposes,  therefore,  a  fairly  complete  departmental 
curriculum  and  organization  with  the  understanding  brought  out  in 
the  written  agreement  with  each  normal  school,  college,  or  university 
concerned,  that  personnel  will  be  selected  in  each  activity  covered 
by  the  program  with  special  reference  to  its  ability  to  handle  suc- 
cessfully the  problems  in  venereal  disease  that  may  be  logically  con- 
sidered by  the  group  of  students  taking  part  in  that  activity. 

In  proposing  this  organization  the  board  has  not  undertaken  to 
dominate  the  educational  method  or  text  presentation  in  any  of  the 
educational  institutions  with  which  it  has  come  into  cooperative 
relationship.  It  is  assumed  that  each  of  these  institutions  is  a  high- 
class  educational  organization  that  may  be  depended  upon  to  select 
with  experienced  educational  intelligence  the  methods  of  instruction 
that  are  most  likely  to  fit  the  special  needs  of  its  own  particular 
student  body.  Each  of  these  institutions  may  be  regarded  as  being 
engaged  in  carrying  out  a  research  for  the  discovery  and  demon- 
stration of  better  methods  of  education  in  the  prevention  of  venereal 
diseases. 

With  these  principles  and  purposes  in  view,  the  Interdepartmental 
Social  Hygiene  Board  adopted  rules  and  regulations  to  govern  the 
funds  provided  by  Congress  for  this  activity.  The  appendix  con- 
tains these  rules  and  regulations  in  full.     (See  Appendix  Fl.) 

By  the  end  of  June,  1919,  appropriations  had  been  made  to  24 
different  institutions.  (See  Appendix  F2)  for  application  form 
for  appropriation  from  "  Educational  research  and  development 
fund.")  In  the  case  of  23  normal  schools  and  colleges,  the  appro- 
priation went  for  the  organization  or  extending  of  departments  of 
hygiene.  The  other  appropriation  was  made  to  the  psychological 
laboratory  of  Johns  Hopkins  University  for  the  purpose  of  under- 
taking a  research  to  determine  the  informational  and  educational 
values  of  certain  motion- picture  films  and  other  material  used  in 
connection  with  various  compaigns  that  have  been  carried  on  for  the 
control,  repression,  and  elimination  of  venereal  diseases. 

The  total  of  the  appropriations  made  to  these  24  institutions 
amounted  to  $166,090.  To  balance  these  appropriations  from  Fed- 
eral funds  the  institutions  themselves  have  appropriated  as  their 
share  in  the  work  a  total  of  more  than  $161,000.     It  is  entirely  safe 


188      REPOET  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

to  say  that  the  amount  spent  by  the  institutions  themselves  to  supple- 
ment the  Federal  appropriations  from  this  fund  will  considerably 
surpass  the  Federal  appropriation.  In  the  case  of  one  of  the  largest 
institutions,  for  example,  the  University  of  Pennsylvania  School  of 
Elducation,  the  amount  to  be  paid  by  the  institution  itself  is  not 
indicated  in  the  application.  The  proportion  between  the  amount 
appropi'iated  by  the  Interdepartmental  Social  Hj^giene  Board  and 
the  amount  to  be  spent  by  the  institution  itself  varies  greatly.  In 
some  cases  the  Interdepartmental  Social  Hygiene  Board  pays  a  con- 
siderably larger  share  of  the  expenses,  as  in  the  case  of  the  Women's 
Medical  College  of  Pennsylvania,  whose  application  indicates  that 
the  board's  appropriation  of  $2,505  is  to  be  supplemented  by  $350  by 
the  institution.  In  other  cases  the  institution  pays  considerably 
more,  as  in  the  case  of  the  Michigan  State  Normal  College,  where  the 
application  indicates  that  the  board  appropriation  of  $3,225  is  to  be 
balanced  by  the  expenditure  of  $17,474  by  the  college. 

In  making  these  comparisons  one  must  not  lose  sight  of  thef  act  that 
each  of  these  institutions  supports  certain  very  important  expenses 
that  cannot  be  easily  estimated  in  such  a  relationship.  The  cost  of 
equipment,  supplies,  light,  heat,  ventilation,  janitor  service,  repairs, 
replacements,  and  general  administration  represents  essential  ex- 
penses that  have  not  been  considered. 

As  to  the  number  of  men  and  women  affected  by  these  appropria- 
tions to  aid  departments  of  hygiene,  it  is  a  question  whether  the  fig- 
ures available  on  the  applications  for  the  period  under  discussion  can 
be  considered  of  very  much  value.  In  the  first  place,  the  board  asked 
for  information  from  the  institutions  only  as  to  the  numberof  students 
being  prepared  as  teachers,  the  original  thought  being  that  this  class 
would  be  the  most  important  to  influence  in  the  matter  of  better  edu- 
cational methods  for  the  prevention  of  venereal  disease.  Again,  the 
figures  given  by  the  institutions  did  not  appear  in  all  cases  to  be  care- 
ful estimates,  and  in  any  case  they  can  be  estimates  only,  as  they  were 
made  up  for  the  school  year  which  was  to  begin  September,  1919. 
Bearing  these  facts  in  mind,  however,  it  may  be  stated  that  the  figures 
available  July  1,  1919,  indicate  over  18,000  men  and  women  under 
the  direct  influence  of  the  courses  of  hygiene  to  be  established  with 
Federal  assistance  during  the  coming  school  year. 

A  summary  of  the  information  connected  with  the  expenditures 
from  the  educational  research  and  development  fund  follows.  It 
should  be  carefully  borne  in  mind  that  this  summary  is  taken  from 
information  carried  in  the  applications  presented  to  the  board  by 
the  institutions.  These  applications  were  intended  simply  as  ten- 
tative forecasts  and  will  undoubtedly  of  necessity  be  changed  con- 
siderably when  put  into  practical  operation.  However,  the  figures 
are  of  value  as  indicating  the  general  extent  of  the  work  laid  out 
under  this  fund. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      189 

Summary  of  factx  conncctej]  iinth  expenditurea  from  cdi(catroniil  reftearcJi  imd 

developmetit  fund. 
Number  of  institutions 24 

(23    normul     scliools    and    colleges    for    departments    nf 
hygiene  and   1  psychological  lal)oratory   of  Johns  Hopkins 
University,  for  investigating  the  effects  of  certain  motion- 
picture  films.) 
Total  number  of  students  affected  (see  note  above)  : 

Women 11,241 

Men 7, 161 

Total 18,  402 

(At  Reed  College  "260  other  physical  education  students" 
beside  those  in  A.  B.  courses.  Would  make  total  18,662. 
No  students  counted  at  Johns  Hoiikins.  University  of  Penn- 
sylvania does  not  separate  men  and  women;  estimate  used.) 

Total  budgets - —  $327, 185.  85 

Amount  furnished  by  Interdepartmental  Social  Hygiene  Board 166,  090.  00 

Amount  furnished  by  institutions  (see  note  above) 161,095.85 

(Amount  furnished  by  one  institution  not  reported.) 

An  analysis  follows  showing  the  amounts  made  available  during  the 
coming  college  year  for  teaching  services  in  connection  with  the 
instruction  in  hygiene  and  the  development  of  better  educational 
methods  in  the  prevention  of  venereal  diseases.  Due  to  the  action  of 
■Congress  and  to  the  policies  of  this  board  in  making  appropriations 
available  for  this  purpose,  there  will  be  departments  of  hygiene  estab- 
lished or  enlarged  in  23  colleges  and  universities  throughout  the 
country  during  the  school  year  of  1919-20.  At  least  $327,000  will 
be  spent  on  hygiene  instruction.  Two  hundred  and  fourteen  special 
teachers,  including  directors,  health  examiners,  teachers  of  hygiene 
and  physical  training,  will  be  employed  in  developing  a  nation-wide 
program  of  health  instruction  with  a  proper  emphasis  on  the  venereal 
diseases.  The  214  special  teachers  mentioned  does  not  take  into  ac- 
count the  additional  minor  positions  necessary  for  the  conduct  of 
such  departments — the  special  public-health  lectures  by  State  and 
National  authorities,  the  special  researches  and  other  unique  features 
incidental  to  the  operation  of  the  program.  Careful  provision  has 
been  made  for  all  these.  This  appropriation  has,  in  fact,  made  pos- 
sible the  inception  of  a  broad  movement  in  health  education.  Its 
finest  fruits,  perhaps,  may  not  be  gathered  for  a  generation.  It  is 
desirable,  however,  to  establish  the  point  at  this  time  that  it  has  been 
by  the  leadership  and  financial  assistance  of  the  Federal  Government 
that  this  fundamental  work  of  educating  educators  in  hygiene,  in- 
cluding the  part  played  therein  by  the  venereal  diseases,  was  made 
possible. 


190      REPORT  U,  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 


4.  United  States  Public  Health  Ser\ice  Venereal  Disease  Fund. 

In  addition  to  the  appropriations  already  treated,  the  Chamberlain- 
Kahn  Act  carried  an  appropriation  of  $1,000,000  annually  for  two 
years  to  be  allotted  to  the  States  for  the  use  of  their  departments  of 
health  in  the  prevention,  control,  and  treatment  of  venereal  diseases. 
This  fund  was  to  be  allotted  in  accordance  with  rules  and  regulations 
prescribed  by  the  Secretary  of  the  Treasury  in  the  usual  manner  of 
making  such  allotments,  namely,  in  the  proportion  which  the  popu- 
lation of  each  State  bears  to  the  population  of  the  continental  United 
States.  During  the  first  year  of  operations  it  was  not  necessary  for 
the  States  to  make  appropriations  of  ^.mounts  equivalent  to  the  allot- 
ments for  the  same  purpose,  but  it  will  be  necessary  during  the  second 
year  in  order  that  the  Federal  allotments  may  be  legally  paid  to  the 
States. 

The  regulations  governing  the  allotment  of  these  funds  were  pro- 
mulgated under  date  of  September  4,  1918,  by  the  Secretary  of  the 
Treasury  and  are  given  in  detail  in  the  appendix.  (See  Ap- 
pendix D.) 

In  accordance  with  the  above  regulations  it  will  be  noted  that  the 
allotmeiits  are  to  be  expended  in  accordance  with  an  accounting  sys- 
tem to  be  forwarded  by  the  Interdepartmental  Social  Hygiene  Board. 
The  board  issued  rules  and  regulations  governing  expenditures  from 
those  State  allotments,  which  are  also  given  in  detail  in  the  appendix. 
(See  Appendix  D.) 

During  the  first  year  46  States  had  complied  with  the  requirements 
contained  in  the  rules  and  regulations  of  the  Secretary  of  the  Treasury 
and  have  received  their  allotments  from  the  Chamberlain-Kahn 
funds.  There  follows  a  list  of  these  States,  giving  in  each  case  the 
amount  of  the  allotment  and  the  date  on  which  checks  covering  these 
amounts  were  mailed  to  each  State : 


state. 


Alabama 

Arizona..' 

Arkansas 

California 

Colorado 

Connecticut... 

Delaware 

Florida 

Georgia 

Idaho 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts, 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 


Allotment. 


S23, 
2, 

17. 

25, 
8, 

12, 
2, 

8, 
28, 

3, 
61, 
29, 
24, 
18, 
24, 
18, 

S, 
14, 
36, 
30, 
22, 
19, 
35, 

4, 


247. 15 
221.91 
118.74 
850.72 
687.66 

120. 57 
199. 81 
183. 11 

368. 56 
540. 13 
307.51 
366. 20 

189. 58 
385.42 
897.77 
009. 65 
071. 68 
084.09 
602.51 

554. 57 
568. 85 
539.74 
807.91 
088. 76 


Date. 


Oct. 
Nov, 
Oct. 
Oct. 
Oct. 
Oct. 
Oct. 


1. 1918 
12, 1918 

28. 1918 
1, 1918 
3, 1918 
4, 1918 
1, 1918 

Nov.  15,1918 
Oct.      1, 1918 

13. 1919 
1,1918 
5, 1918 
4, 1918 
2, 191S 

Do. 
Oct.  29,1918 
15,1918 
24, 1918 
15, 1918 
23, 1918 
15,1918 
Do. 
June  14,1919 
Oct.     4, 1918 


Mar 
Oct. 
Oct. 
Oct. 
Oct. 


Oct. 
Oct. 
Oct. 
Dec. 
Oct. 


State. 


Nebraska 

New  Hampshire. 

New  Jersey , 

New  Mexico , 

New  York 

North  Carolina. . 
North  Dakota. . . 

Ohio 

Oklahoma 

Oregon 

Rhode  Island. . . . 
South  Carolina. . 
South  Dakota... 

Tennessee 

Texas 

Utah 

Vermont 

Virgima 

Washington 

West  Virginia. . . 

Wisconsin 

Wyoming 


Total 912,168. 


Allotment. 


Date. 


S12, 

4, 

27, 

3, 

99, 

23, 

6, 

51, 

18, 

7, 

5, 

16, 

6, 

23, 

42, 

4, 

3, 

22, 

12, 

13, 

25, 

1, 


962.75 
681.54 
586. 22 
558.70 
090.89 
988. 61 
274.24 
832.16 
017.99 
314. 87 
899.72 
476.71 
348. 52 
754. 87 
366.49 
059. 39 
870.26 
415.58 
416.68 
277.04 
375.70 
587.05 


Dec.  4, 
Oct.  3, 
Oct.  21, 
May  17, 
Oct.  1, 
Nov.  14, 
Oct.  21, 
Oct.  15, 
Oct.  28, 
Oct.  24, 
Oct.  15, 
Oct.  3, 
Oct.  7, 
June  26, 
Oct.  15, 
Feb.  25, 
Nov.  20, 
Nov.  2, 
Oct.  21, 
Oct.  4, 
Oct.  2, 
Do. 


1918 
1918 
1918 
1919 
1918 
1918 
1918 
1918 
1918 
1918 
1918 
1918 
1918 
1919 
1918 
1919 
1918 
1918 
1918 
.1918 
,1918 


EEPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.     191 

The  allotments  not  accepted  were  as  follows : 

District  of  Columbia .$3,599.66 

Nevada 890.  21 

Pennsylvania 83,341.55 

Total 87,831.42 

At  the  close  of  the  first  year  all  but  4  of  the  46  States  which  re- 
ceived their  allotments  had  an  organized  bureau  for  venereal  disease 
control.  The  four  States  are  Idaho,  Missouri,  New  Mexico,  and  Ten- 
nessee. Of  the  46  States  which  received  their  allotments  for  the  past 
fiscal  year,  34  have  already  appropriated  funds  to  entitle  them  to 
receive  the  Federal  allotment  for  1919-20. 

A  complete  statement'  covering  the  work  of  the  States  and  the 
United  States  Public  Health  Service  under  the  Chamberlain -Kahn 
funds  will  be  found  in  the  Annual  Eeport  of  the  Surgeon  General 
of  the  Public  Health  Service  of  the  United  States  for  the  fiscal  year 
1919,  under  the  activities  of  the  Division  of  Venereal  Diseases. 


Part  IV. 

APPENDICES. 

Page. 

A.  1.  Federal   law   under   which   the   United    States    Interdepartmental 

Social  Hygiene  Board  operates.     (Chap.  15,  Pub.  No.  193,  65th 
Cong.,  H.  R.  12281) 197 

2.  Amendments  to  law : 

a.  Reappropriations  for   the  year  ending  June  30,   1920    (Pub. 

No.  21,  66th  Cong.,  H.  R.  7343) 199 

h.  Extension  of  duties  and  powers  and  appropriations  for  the 

fiscal  year  ending  June  30,  1921 199 

B.  1.  Regulations  for  assistance  of  institutions  in  the  maintenance  of 

venereally  infected  patients . 201 

2.  Form  of  request  for  maintenance  of  venereally  infected  patients —       201 

C.  1.  Functions  of  the  protective  social  measures  staff ^ 203 

2.  Form  of  proposal  for  governmental  assistance  in  the  organization 

of  bureaus  of  protective  social  measures  in  State  departments  of 
health —       211 

D.  Regulations  governing  expenditures  of  State  allotments  from  the 

Chamberlain-Kahn   Funds 214 

E.  1.  Regulations  governing  the  scientific  research  fund 229 

2.  Application  form  for  scientific  research 230 

F.  1.  Regulations  governing  the  educational   research  and  development 

fund 232 

2.  Application  form  for  establishmnt  or  enlargement  of  departments 

of  hygiene  in  normal  schools,  colleges,  and  universities 239 

G.  1.  Regulations  governing  payments  to  State  universities  for  the  estab- 

lishment of  divisions  of  educational  hygiene  in   State  depart- 
ments of  education 245 

2.  Form  letter  of  agreement  from  State  universities  to  assign  adminis- 
trative personnel  to  State  departments  of  public  education 245 

H.       List  of  publications  on  hand  June  30,  1920 248 

192 


SPECIAL    APPENDIX. 

Cost  of  Venereal  Diseases. 

Estimatas  from  the  financial  viewpoint  on  the  meaning  of  venereal  dis- 
eases in — 

1.  The  United  States  Army. 

2.  The  State  of  Massachusetts  ( selected  group). 

3.  The  St.  Louis-Southwestern  Railway  Lines. 

4.  England. 

1.  items  eegakding  the  cost  of  \tsnereal  diseases  in  the  army. 

[l,etter  from  the  Chief  of  the  Division  of  Sanitation,  Col.  Weston  P.  Chamberlain,  M.  C, 
U.  S.  Army,  Office  of  the  Surgeon  General  of  the  Army.l 

War  Department, 
Office  of  the  Surgeon  General, 

Wasliington,  October  15,  1920. 
Dr.  T.  A.  Storey,  Executive  Secretanj, 

United  States  Interdepartmental  Social  Hygiene  Board, 

1800  Virginia  Avenue,  NW.,  Washington,  D.  C. 

Dear  Dr.  Storey  :  With  reference  to  your  letter  of  September  29,  the  Sur- 
geon General  directs  me  to  state  that  statistics  relative  to  the  occuiTence  of 
venereal  diseases  among  the  troops  of  the  United  States  Army  have  recently 
been  made  available  to  a  representative  from  your  office.^ 

With  reference  to  the  cost  of  venereal  disease  to  the  Army  during  the  fiscal 
year  ending  June  30,  1920,  I  regret  to  say  that  no  figures  have  yet  been  com- 
piled upon  which  to  base  an  estimate.  I  have,  however,  caused  a  study  of  this 
cost  to  be  made  for  the  calendar  year  1919. 

During  the  calendar  year,  from  January  1,  1919,  to  December  31,  1919. 
venereal  diseases  in  the  Army  caused  a  loss  of  1,923,420  days.  Since  practically 
all  of  this  lost  time  represents  days  spent  in  hospital  under  treatment  for 
gonorrhea,  chancroid,  or  syphilis,  and  since  a  fair  estimate  of  the  cost  of 
such  hospitilization  for  each  patient  per  day  is  $7,  it  may  be  said  that  the 
diref't  loss  to  the  Army  caused  by  these  diseases,  measured  in  dollars,  was 
ifl3,463,940. 

During  the  period  of  his  incapacity  for  active  duty  by  reason  of  venereal 
disease  the  soldier  is  deprived  of  pay,  and  later  at  the  expiration  of  his  term 
of  enlistment  is  required  to  make  up  the  time  so  lost  by  equivalent  additional 
service.  The  loss  of  his  services  at  the  time  of  his  incapacity  is  thus  not  a 
direct  loss  to  the  Army  except  as  it  reduces  the  available  man  power  at  that 


'This  table 'under  the  caption  of  "  Vonoreal  disease  in  the  Army"  appears  on  page  94 
of  this  Report. 

15610—20 13  193 


194      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

time  and  requires  tlie  services  of  another  man  in  the  phice  of  the  noneffective. 
Such  loss,  while  substantial,  can  not  well  be  measured  in  money. 

The  Army  suffers  further  substantial  loss  in  the  time  and  effort  spent  in 
the  training  of  men  who  subsequently  become  noneffective  because  of  venereal 
disease  and  are  discharged.     This  loss  is  not  subject  to  definite  measurement. 

There  should  be  included  in  the  estimates  the  cost  of  salvarsan  used  in  the 
treatment  of  syphilis,  which  represents  a  large  item  of  expense.  Exact  figures 
of  this  are  not  available.  The  cost  of  prophylactic  treatments,  not  measurable 
in  dollars,  is  considerable  and  may  also  properly  be  added. 

It  may  be  conservatively  estimated,  however,  that  the  actual  hjss  to  the  Army 
caused  by  venereal  diseases  during  the  year  1919  was  not  less  than  $15,000,000. 
Very  truly,  yours, 

W.  P.  Chamberlain, 
Colonel,  Medical  Corps. 


Strength  of  the  Army  during  period   {calendar  year,  1919)  covered   by  Col. 

Chamhei'lain's  letter. 


Months,  1919. 


January 

February . . 

March 

April 

May 

June 

July 

August 

September . 

October 

November . 
December. . 


Total 

Mean  strength  per  month,  1919 . 


Officers. 


122, 234 
104,810 
93,008 
81, 132 
66,918 
52,295 
39, 191 
30,080 
25, 189 
20, 877 
15, 645 
15, 273 


666, 652 


55, 554 


American  troops. 


White. 


2,212,359 

1,879,940 

1, 628, 823 

1,325,047 

996, 038 

648, 715 

427,064 

257, 885 

211,405 

185,867 

172,860 

175,403 


10,121,406 


843, 451 


Colored. 


230, 288 

203, 273 

170,919 

152, 320 

140, 609 

114,696 

40,870 

21,595 

14,742 

10,989 

10,711 

10,668 


93,473 


Total. 


2, 442, 647 

2, 083, 213 

1,799,742 

1,477,367 

1,136,647 

763,411 

467,934 

279,480 

226, 147 

196, 856 

183,571 

186,071 


11,243,086 


936, 924 


Total 

enlisted, 

including 

native 

troops. 


2, 463, 274 

2, 099, 774 

1, 813, 893 

1,490,326 

1,148,829 

776, 137 

478, 883 

289, 565 

236,420 

206, 775 

193,563 

196, 469 


11,393,908 


949,492 


Total 

officers  and 

enlisted, 

including 

native 

troops. 


2, 585, 508 

2,204,584 

1,906,901 

1,571,458 

1,215,747 

828,432 

518,074 

319,645 

261,609 

227,652 

209,208 

211,742 


12,060,560 


1,005,047 


Mean  strength  per  month  from  Jan.  1, 1920,  to  June  30, 1920  (this  includes  all  native  troops  as  in  the 
statement  for  1919): 

Officers 15, 205 

Enlisted  men 196, 595 

Total 211, 800 


2.  ITEMS  EEGAKDING  THE  COST  OF  VENEREAL  DISEASES  IN  THE  STATE  OF  MASSA- 
CHUSETTS    FOR    A     SELECTED    GROUP     OF     100     MEN     WHO     DIED    FROM     SYPHILITIC 

INSANITY. 

[Extract  from  "  The  relation  of  alcohol  and  syphilLs  to  mental  hygiene,"  by  Frankwood  E. 
Williams,  M.  D.,  in  the  American  .Journal  of  Public  Health,  vol.  6,  No.  12,  pp.  1272- 
1277,  December,  1916.] 

*  *  *  Here  were  100  men,  engaged  in  various  pursuits.  Seventy-eight 
were  married,  22  were  single.  They  were  economic  units  in  the  community, 
each  .supporting  himself,  and  in  many  cases  each  isupporting  others — each  of 
value  to  himself,  to  his  famirly,  and  to  the  community.  Each  made  his  daily 
and  .weekly  contribution  to  the  work  of  the  world.  Syphilis  intervened,  with 
insanity  and  premature  death  resulting. 

An  estimation  of  the  loss  of  life,  based  on  insurance  tables  showing  the 
expectation  of  life,  and  taking  into  considenition  such  factors  as  race,  occupa- 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     195 

tion,  etc.,  shows  that  tlie  loss  of  life  in  individutil  cases  had  been  from  8  to 
38  years.     The  100  men  lost  a  total  of  2,259  years. 

By  the  intervention  of  this  disease  these  100  men  ceased  to  be  productive. 
The  hospital  records  show  the  earning  power  before  connnitment  to  the  hos- 
pital of  only  10  men,  so  that  the  loss  of  earning  power  can  be  estimated  for 
but  10.  Previous  to  their  connnitment  these  men  were  earning  from  $11  to 
$37.50  a  week.  The  financial  loss  created  by  the  premature  death  of  these  10 
men,  based  upon  the  expectation  of  life  and  their  earning  capacity  before  com- 
mitment, was  $212,248.  But  tliese  men  not  only  lost  their  earning  power,  they 
became  parasitic  upon  the  community.  The  hospital  residence  of  the  100  men 
amounted  to  a  little  over  126  year's,  or  an  average  of  a  little  over  1  year 
apiece.  This,  at  the  cost  of  $6  per  week  to  the  State  of  Massachusetts  for 
the  maintenance  of  these  men,  the  Commonwealth  of  Massachusetts  expended 
over  $39,312.  By  the  intervention  of  the  disease  wives  and  children  were  left 
unsupported.  Wives  were  left  to  shift  for  themselves  and  to  care  for  their 
children  unaided.  The  continuity  of  the  home  life  was  destroyed ;  the  chil- 
dren, who  should  have  continued  in  school  in  preiiaration  for  their  life  in  tlie 
community,  were  turned  out  at  an  early  age  upon  the  community,  either  to  work 
in  unskilled  labor  for  the  support  of  themselves  and  other  members  of  their 
family  or  as  public  charges  in  charitable  institutions.  One  hundred  and  nine 
were  so  left.  A  not  unimportant  per  cent — this  per  cent  has  not  yet  been  de- 
termined— were  diseased  and  thrown  upon  the  community  in  a  crippled  condi- 
tion, their  disea.se  being  directly  due  to  the  infection  of  their  fathers. 

These  are  figures — 2,259  years'  loss  of  life ;  .$212,248  loss  of  earning  power 
(10  men)  ;  $39,312  expended  by  the  State  for  support;  109  children  cheated  of 
their  rights  of  home  protection — for  but  100  male  patients  in  a  representative 
hospital,  but  from  them  we  may  gain  some  notion  of  the  tremendous  loss  to 
the  community  each  year  due,  and  due  entirely,  to  .syphilitic  mental  disease. 

Mental  disease  constitutes  a  serious  public-health  problem.  Massachusetts 
in  the  last  10  years  has  received  over  26,0<!)0  new  patients  into  her  State  hos- 
pitals. Thej*  come  at  the  rate  of  over  3,000  new  patients  each  year.  In  the 
last  10  years  Massachusetts  has  expended  over  $35,000,000  in  the  maintenance 
of  these  individuals.  Twenty  per  cent  of  the  patients  who  have  come  because 
of  alcohol ;  10  per  cent  have  come  because  of  syphilis.     *     *     * 

3.    ITE\fS    REGARDING    THK    COST    OF    VENEREAL    DISEASES    TO    THE    ST.    LOUIS-SOUTH- 
WESTEKN    RAILWAY    LINE.S. 

[The  following  tables  are  taken  fi-om  the  article  bj'  Archibald  E.  Cliace,  M.  D.,  F.  A.  C.  S., 
Chief  Surgeon  of  the  St.  Louis-Southwestern  Railway  Lines,  Texarkana,  Arkansas- 
Texas,  on  "  The  venereal  campaign  among  railway  employees,"  published  in  the 
October,  1920,  number  of  "The  Journal  of  Industrial  Hygiene."] 

Table  1. — Statistics  of  cases  from  free  venereal  service  at  Texarkana  Hospital, 
medical  department,  St.  Louis  Southwestern  Raihcay  lines. 


Diseases. 

1918  new 
cases. 

1919  new 
cases. 

Per  cent 
increase. 

1919  per 

cent 

cured. 

1919  per 

cent 

probably 

cured. 

1919  per 

cent 
A.  AV. 

0.  L. 

Syphilis 

.5P,               80 
83              125 
18                 59 

53 
50 
61 

79 

fJonorrhea 

25 
10 

C9 

Chancroid 

48 
100 

38 

Other  venereal  diseases 

1 

*   *   *  *  i     

Total  or  average 

157                   941    1                 S3 

6 

'  14                  '■■0 

196      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 


Table  2. — Cost  of  venereal  service  at  Texarlcatia  Hospital,  St.  Louis  South- 

wester7i  Ro/ilway  lines. 


Diseases. 


Cost  11 

months, 

1919. 


Cost  per 
case. 


Cost  to 
complete 


Syphilis 

Gonorrhea 

Chancroid 

Other  venereal  diseases 

Total  or  average. 


$5, 235. 49 

5,695.95 

953. 81 

29.90 


11,915.15 


54 


8200 
125 
50 


143 


4.    ITEMS   liEGARDING   THE   COST  OF   \'ENEEEAL   DISEASES   IN   ENGLAND. 

[Extract  from  the  "  Foreign  letters  "  column  of  the  "  Journal  of  the  American  Medical 
Association,"    Oct.    9,    1920,    p.    1012.] 

EIKST  REPORT  OF  THE  MINISTRY  OF  HEALTH. 

London,  September  18,  1920. 
The  first  annual  report  of  the  newly  created  ministry  of  health  is  largely 
concerned  with  the  costs  of  the  various  services,  which  are  increasing  to  an 
enormous  extent.  The  most  important  part  deals  with  venereal  disease.  Up- 
ward of  98,000  cases  were  reported  for  the  first  time  in  1919,  but  15,500  of  the 
patients  were  found  not  to  be  suffering  from  venereal  disease.  Attendances  at 
the  treatment  centers  numbered  1,063,000,  as  compared  with  488,000  in  1919. 
Even  allowing  for  the  increased  tendency  to  seek  treatment  and  for  the  addi- 
tional facilities  provided,  it  is  evident  that  venereal  disease  is  not  being  pre- 
vented. The  cost  for  the  year  ending  March  31,  1919,  was  a  little  over  $1,000,- 
000,  exclusive  of  grants  for  propaganda. 


Appendix  A. 

1.  FEDERAL     LAW     UNDER     WHICH     THE     INTERDEPARTMENTAL 
SOCIAL  HYGIENE  BOARD  OPERATES. 

[Chap.  15,  Public,  No.  193,  65tli  Cong.,  H.  R.  12281.] 

AN  ACT  Making  appropriations  for  the  support  of  the  Army  for  the  fisciil  year  ending 

June  30,  1919. 

CHAPTER   XV, 

Interdepartmental  Social  Hygiene  Board :  That  there  is  hereby  created  a 
board  to  be  known  as  the  Interdepartmental  Social  Hygiene  Board,  to  consist 
of  the  Secretary  of  War,  the  Secretary  of  tlie  Navy,  and  the  Secretary  of  the 
Treasury  as  ex  officio  members,  and  of  the  Surgeon  General  of  the  Army,  the 
Surgeon  General  of  the  Navy,  and  the  Surgeon  General  of  the  Public  Health 
Service,  or  of  representatives  designated  by  the  Secretary  of  War,  the  Secre- 
tai'y  of  the  Navy,  and  the  Secretary  of  the  Treasury,  respectively.  The  duties 
of  the  board  shall  be  (1)  to  recommend  rules  and  regulations  for  the  expendi- 
ture of  moneys  allotted  to  the  States  under  section  5  of  this  chapter;  (2)  to 
select  the  institutions  and  organizations  and  fix  the  allotments  to  each  institu- 
tion under  said  section  5;  (3)  to  recommend  to  the  Secretary  of  the  Treasury, 
the  Secretary  of  ^Var,  and  the  Secretary  of  the  Navy  such  general  measures 
as  will  promote  correlation  and  efficiency  in  carrying  out  the  purposes  of  this 
chapter  by  their  re.spective  departments;  and  (4)  to  direct  the  expenditure  of 
the  sum  of  $100,000  referred  to  in  the  last  paragraph  of  section  7  of  this  chapter. 
The  board  shall  ni'eet  at  least  quarterly  and  sliall  elect  annually  one  of  its 
members  as  chairman  and  shall  adopt  rules  and  regulations  for  the  conduct 
of  its  business. 

Sec.  2.  That  the  Secretary  of  War  and  the  Secretary  of  the  Navy  are  hereby 
authorized  and  directed  to  adopt  measures  for  the  purpose  of  assisting  the 
various  States  in  caring  for  civilian  persons  whose  detention,  isolation,  quaran- 
tine, or  commitment  to  institutions  may  be  found  necessary  for  the  protection 
of  the  military  and  naval  forces  of  the  United  States  against  venereal  diseases. 

Sec.  3.  That  there  is  hereby  established  in  the  Bureau  of  Public  Health 
Service  a  Division  of  Venereal  Diseases,  to  be  under  the  charge  of  a  commis- 
sioned medical  officer  of  the  United  States  Public  Health  Service  detailed  by 
th€  Surgeon  General  of  the  Public  Health  Service,  which  officer  while  thus 
serving  shall  be  an  Assistant  Surgeon  General  of  the  Public  Health  Service, 
subject  to  the  provisions  of  law  ai^plicable  to  assistant  surgeons  general  in 
charge  of  administrative  divisions  in  the  District  of  Columbia  of  the  Bureau 
of  Public  Health  Service.  There  shall  be  in  such  division  such  assistants, 
clerks,  investigators,  and  other  employees  as  may  be  necessary  for  the  per- 
formance of  its  duties  and  as  may  be  provided  for  by  law. 

Sec.  4.  That  the  duties  of  the  division  of  venereal  diseases  shall  be  in  ac- 
cordance with  rules  and  regulations  prescribed  by  the  Secretary  of  the  Treas- 
ury (1)  to  study  and  investigate  the  cause,  treatment,  and  prevention  of 
venerea!    diseases;    (2)    to   cooperate   with    State   boards   or   departments   of 

197 


198      BEPORT  "U.  S.  INTERDEPARTMENTAJ^  SOCIAL  HYGIENE  BOARD. 

health  for  the  prevention  and  control  of  such  diseases  within  the  States; 
and  (3)  to  control  and  prevent  the  spread  of  these  diseases  in  interstate 
traffic:  Provided,  That  nothing  in  this  chapter  shall  be  construed  as  limiting 
the  functions  and  activities  of  other  departments  or  bureaus  in  the  prevention, 
control,  and  treatment  of  venereal  diseases  and  in  the  expenditure  of  moneys 
therefor. 

Sec.  5.  That  there  is  hereby  appropriated,  out  of  any  money  in  the  Treasury 
not  otherwise  appropriated,  the  sum  of  $1,000,000,  to  be  expended  under  the 
joint  direction  of  the  Secretary  of  War  and  the  Secretary  of  the  Navy,  to 
carry  out  the  provisions  of  section  2  of  this  chapter :  Provided,  That  the  ap- 
propriation herein  made  shall  not  be  deemed  exclusive,  but  shall  be  in  addition, 
to  other  appropriations  of  a  more  general  character  which  are  applicable  to  the 
same  or  similar  purposes. 

Sec.  6.  That  there  is  hereby  appropriated,  out  of  any  moneys  in  the  Treasury 
not  otherwise  appropriated,  the  sum  of  $1,400,000  annually  for  two  fiscal 
years,  beginning  with  the  fiscal  year  commencing  July  1,  1918,  to  be  appor- 
tioned as  follows:  The  sum  of  $1,000,000,  which  shall  be  paid  to  the  States 
for  the  use  of  their  respective  boards  or  departments  of  health  in  the  pre- 
vention, control,  and  treatment  of  venereal  diseases ;  this  sum  to  be  allotted 
to  each  State,  in  accordance  with  the  rules  and  regulations  prescribed  by  the 
Secretary  of  the  Treasury,  in  the  proportion  which  its  population  bears  to 
the  population  of  the  continental  United  States,  exclusive  of  Alaska  and  the 
Canal  Zone,  according  to  the  last  preceding  United  States  census,  and  such 
allotment  to  be  so  conditioned  that  for  each  dollar  paid  to  any  State  the 
State  shall  specifically  appropriate  or  otherwise  set  aside  an  equal  amount 
for  the  prevention,  control,  and  treatment  of  venereal  diseases,  except  for 
the  fiscal  year  ending  June  30,  1919,  for  which,  the  allotment  of  money  is  not 
conditioned  upon  the  appropriation  or  setting  aside  of  m.oney  by  the  State: 
Provided,  That  any  State  may  obtain  any  part  of  its  allotment  for  any  fiscal 
year  subsequent  to  June  30,  1919,  by  specifically  appropriating  or  otherwise 
setting  aside  an  amount  equal  to  such  part  of  its  allotment  for  the  prevention, 
control,  and  treatment  of  venereal  diseases;  the  sum  of  $100,000,  which  shall 
be  paid  to  such  universities,  colleges,  or  other  suitable  institutions  as  in  the 
judgment  of  the  Interdepartmental  Social  Hygiene  Board  are  qualified  for 
scientific  research  for  the  purpose  of  discovering,  in  accordance  with  rules 
and  regulations  prestribed  by  the  Interdepartmental  Social  Hygiene  Board, 
more  effective  medical  measures  in  the  prevention  and  treatment  of  venereal 
diseases ;  the  sum  of  $300,000,  which  shall  be  paid  to  such  universities, 
colleges,  or  other  suitable  institutions  or  organizations  as  in  the  judgment  of 
the  Interdepartmental  Social  Hygiene  Board  are  qualified  for  scientific  re- 
search for  the  purpose  of  discovering  and  developing  more  etfective  educational 
measures  in  the  prevention  of  venereal  diseases  and  for  the  purpose  of  socio- 
logical and  psychological  research  related  thereto. 

Sec.  7.  That  there  is  hereby  appropriated,  oiit  of  any  money  in  the  Treasury 
not  otherwise  appropriated,  the  sum  of  $800,000  for  the  fiscal  year  ending 
June  30,  1919,  to  be  apportioned  as  follows :  The  sum  of  $200,000  to  defray  the 
expenses  of  tlie  establishment  and  maintenance  of  the  Division  of  Venereal 
Diseases  in  tlie  Bureau  of  the  I'ublic  Health  Service;  and  the  sum  of  $100,000 
to  be  used  under  the  direction  of  the  Interdepartmental  Social  Hygiene  Board 
for  any  purpose  for  which  any  of  the  appropriations  made  by  this  chapter  are 
avnilable. 

Sec.  8.  That  the  terms  "  State"  and  "  States,"  as  used  in  this  chapter,  shall 
l)e  held  to  include  the  District  of  Columbia. 


REPORT  U.  S,  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      199 
2.  AMENDMENTS  TO  LAW. 

(a)   Reai'proi'Uiations  for  the  Year  Ending  June  30,  1920. 

[Public,  No.  21,  G6th  Cong.,  H.  R.  T.^4:^.] 

AN  ACT  Making  appropriations  for  sundry-civil  cxpensps  of  the  Government  for  the  fiscal 
year  ending  June  30,  1920,  and  for  other  purposes. 

INTERDEPARTMENTAf.    SOCIAL    HYGIENE    ItOARU. 

The  unexpended  liahvnces  on  June  30,  1919,  of  tlie  appropriations  for  the 
fiscal  year  1919  contained  in  sections  5,  6,  and  7  of  chapter  15  of  the  Army 
appropriation  act,  approved  July  9,  191S,  are  reappropriated  and  made  avail- 
able for  the  same  purpo.ses  for  the  fiscal  year  192j0:  Provided,  That  the  un- 
expended balance  of  the  sum  of  $100,000  in  section  7  to  be  used  under  the 
direction  of  the  Interdepartmental  Social  Hygiene  Board  shall  be  available  for 
personal  services  in  the  District  of  Columbia  and  elsevviiere,  books  of  reference 
and  periodicals,  printing  and  binding,  traveling,  and  other  necessary  expenses 
of  the  board  in  the  administration  of  the  provisions  of  chapter  15  of  the  said 
act. 

(6)  Extension  of  Duties  and  Powers  and  Appropriations  for  the  Fiscal 
Year  Ending  June  30,   1921. 

section    of   the    sundry    civil   act   for   fiscal   Y'EAK   ending    JTJNE    30,    1921. 
[Public  No.   246,  66th  Cong.,  2d  sess.,  H.  R.  17870.] 

The  duties  and  powers  conferred  upon  the  Interdepartmental  Social  Hygiene 
Board  by  chapter  15  of  the  Army  appropriation  act  approved  July  9,  1918,  with 
respect  to  the  expenditure  of  the  appropriations  made  therein  are  extended  and 
made  applicable  to  the  appropriations  for  similar  purposes  made  in  this  act. 

For  expenses  of  the  board,  including  personal  services  in  the  District  of 
Columbia  and  elsewhere,  books  of  reference  and  periodicals,  printing  and  bind- 
ing, traveling,  and  other  necessary  expenses,  $80,000. 

For  assisting  the  States  in  protecting  the  military  and  naval  forces  of  the 
United  States  against  venereal  diseases,  $150,000 ;  and  the  unexpended  balance 
on  June  30,  1920  (approximately  $250,000)  of  the  appropriation  heretofore  made 
for  this  pui'pose  is  continued  and  made  available  during  the  fiscal  year  1921 : 
Provided,  That  no  part  of  these  sums  shall  be  expended  in  assisting  reforma- 
tories, detention  homes,  liospitals,  or  other  similar  institutions  in  the  mainte- 
nance of  venereally  infected  persons ;  total,  $400,000. 

For  allotment  to  the  various  States  for  the  prevention,  treatment,  and  control 
of  venereal  diseases,  $450,000;  and  the  unexpended  balance  on  June  30,  1920 
(approximately  $300,000),  of  the  appropriation  heretofore  made  for  this  pur- 
pose is  continued  and  made  available  during  the  fiscal  year  1921 :  Provided, 
That  no  part  of  this  sum  shall  be  allotted  to  any  State  unless  such  State,  in  a 
manner  satisfactoi-y  to  the  board,  shall  have  complied  with  and  shall  have  given 
assurance  of  continued  compliance  with  the  conditions  and  regulations  govern- 
ing such  allotments  and  the  expenditures  that  may  be  made  therefrom ;  total, 
$7.50,000. 

For  payment  to  universities,  colleges,  and  other  suitable  institutions  for 
scientific  research  for  the  purpose  of  discovering  more  effective  medical  meas- 
ures in  the  prevention  and  treatment  of  venereal  diseases,  $85,000. 


200     EEPOKT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

For  payment  to  universities,  colleges,  and  other  suitable  institutions  and 
organizations  for  the  purpose  of  discovering  and  developing  more  effective  edu- 
cational measures  in  the  prevention  of  venereal  diseases,  $250,000. 

No  part  of  the  respective  sums  contained  in  the  two  preceding  paragraphs 
shall  be  paid  to  any  university,  college,  institution,  or  organization  which  does 
not  set  aside  an  additional  sum  for  the  same  purpose  at  least  equal  to  the 
amount  to  be  received  from  the  United  States. 

In  all.  Interdepartmental  Social  Hygiene  Board,  $1,015,000.  "" 


Appendix  B. 

1.  REGULATIONS  FOR  ASSISTANCE  OF  INSTITUTIONS  IN  THE 
MAINTENANCE  OF  VENEREALLY  INFECTED  PATIENTS. 

The  Interdepartmental  Social  Hygiene  Board,  at  a  meeting  held  on  July  22, 
decided  "  that  in  general,  no  further  appropriations  will  be  made  for  the  as- 
sistance of  institutions  in  the  maintenance  of  venereally  infected  patients  under 
the  provisions  of  sections  2  and  5  of  the  Chamberlain-Kahn  bill  unless  satisfac- 
toi-y  assurance  is  secured  (a)  that  the  institution  concerned  is  a  permanent 
establishment,  (b)  that  it  cares  for  persons  infected  witli  venereal  disease  who, 
if  free,  would  be  a  menace  to  soldiers  and  sailors,  (e)  that  a  temporary  emer- 
gency exists  making  financial  help  from  the  board  an  imperative  necessity,  (d) 
that  the  board  of  health  of  the  State  in  which  the  institution  making  applica- 
tion is  located  urgently  recommends  that  the  board  give  the  temporary  financial 
assistance  requested  (e)  that  the  allowance  for  per  capita  cost  per  diem  for 
maintenance  will  not  exceed  the  actual  cost  (maximum  $1.50)  of  such  main- 
tenance, and  that  maintenance  will  not  include  I'ent,  insurance,  overhead,  or 
other  items  of  maintenance  that  do  not  vary  with  the  nu)uber  of  patients  cared 
for  each  day  by  the  institution,  and  (f)  that  the  institution  concerned  provides 
a  wise  policy  of  medical  treatment,  hygienic  instruction,  vocational  education, 
recreation,  and  social  rehabilitation  for  its  inmates." 

2.  FORM  OF  REQUEST  FOR  MAINTENANCE  OF  VENEREALLY 
INFECTED  PATIENTS. 

United  States  Interdepartmental  Social  Hygiene  Board. 

REQUEST    for    MAINTENANCE. 

N.  B. — The  following  questions  should  be  fully  answered  in  the  space  below,  or,  if  morer 
space  is  required,  an  additional  sheet  may  be  used,  but  should  be  securely  fastened  to  this 
form. 

The  answers  should  be  carefully  numbered  to  correspond  with  the  numbers  of  the 
questions. 

This  form  should  be  completed  with  great  care,  and  every  question  should  be  fully  and 
specifically  answered. 

Question  1.   (a)  Name  of  institution,     (b)  Date  of  application. 

Question  2.  Location  (city,  county,  and  State). 

Question  3.  Is  the  institution  a  permanent  establishment? 

Question  4.  Purpose  for  which  established? 

Question  5.  How  financed? 

Question  G.  Give  brief  description  of  institution  (number  of  buildings,  acres- 
under  cultivation,  etc.). 

Question  7.   (a)   Sex  admitted,     (b)  Age  admitted,     (c)   Color  admitted. 

Question  8.  Diseases  excluded. 

Question  9.  Are  inmates  examined  for  venereal  disease  on  admission? 

Question  10.  By  a  man  or  woman  physician? 

Question  11.  Are  venereal  diseases  treated?    Where  and  how? 

Question  12.  Does  the  institution  provide  a  wise  policy  of  hygienic  instruc- 
tion, vocational  education,  recreation,  and  social  rehabilitation  for  its  inmates? 
Give  particulars  briefly. 

201 


202      EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

Question  13.   (a)  Capacity  of  institution,     (h)  Present  number  of  inmates. 

Question  14.  Average  daily  number  of  venereally  infected  ]>ersons  confined 
in  institution  during  the  past  six  montlis. 

Question  15.  («)  Naval  and  militnry  camps  served,  (b)  Location,  (c)  Ap- 
proximate number  of  men  in  each,     (d)  Distance  from  the  institution. 

Question  16.  Does  the  institution  care  for  persons  infected  with  a  venereal 
disease,  who,  if  free,  would  be  a  menace  to  soldiers,  sailors,  and  civilian  pop- 
ulation? 

Question  17.  Law  or  regulations  under  which  commitment  is  made. 

Question  IS.  Does  the  State  board  of  health  urgently  recommend  that  the 
institution  be  given  financial  fissistance  to  the  amount  requested  below? 

Question  19.  Give  a  concise  outline  of  the  personnel  employed  at  the  Institu- 
tion, salaries  paid,  and  the  average  total  cost  per  month  for  the  maintenance 
of  the  institution. 

Question  20.  Average  dnily  cost  for  maintenance  per  person  during  past  six 
months. 

Question  21.  («)  Is  any  part  of  cost  of  maintenance  paid  by  city,  county,  or 
State?     (6)  If  so,  by  whom  and  how  much  per  person? 

Question  22.  Reasons  for  requesting  this  assistance  from  the  United  States 
Interdepartmental  Social  Hygiene  Board. 

Question  23.  Does  a  temporary  emergency  exist  making  financial  help  from 
the  board  an  imperative  necessity? 

N.  B. — The  above  questions  should  be  fully  answered  in  the  space  below,  or,  If  more 
space  is  required,  an  additional  sheet  may  be  used,  but  should  be  securely  fastened  to 
this  form. 

The  answers  should  be  carefully  numbered  to  correspond  with  the  numbers  of  the 
questions. 

24.  To  the  best  of  my  knowledge  and  belief  the  above  answers  are  correct 
and  the  foregoing  information  is  reliable. 

25.  It  is  requested  that  the  United  States  Interdepartmental  Social  Hygiene 

Board  allot  the  sum  of  $ — ,  for  the  period  ,  19 — ,  to  ,  19 — , 

inclusive. 

26.  It  is  further  agreed  that  should  this  request  for  financial  assistance  be 
granted  for  the  maintenance  of  venereally  infected  persons  at  tliis  institution 
monthly  bills  will  be  rendered  upon  forms  provided  by  the  Board,  covering 
the  actual  cost  of  maintenance,  care,  and  treatment  per  capita  per  diem,  and 
that  this  per  diem  charge  is  not  to  exceed  for  any  month  the  maximum  of 
$1.50. 

27.  It  is  further  agreed  that  "  maintenance "  as  herein  understood  will  not 
include  rent,  insurance,  salaries  of  permanent  personnel,  or  any  overhead  or 
other  items  that  do  not  vary  with  the  number  of  patients  cared  for  each  day 
by  the  institution. 

28.    (Signed) 

(Official  title) 

29.  Recommended : 

Executive  Secretary, 
United  States  Interdepartviental  Social  Hygiene  Board. 

30.  Recommendation  approved : 

Chairman  Executive  Committee, 
United  States  Interdevartmental  Social  Hygiene  Board. 

31.  Approved  by  United  States  Interdepartmental  Social  Hygiene  Board  on 
.  19—. 


Appendix  C. 

1.  FUNCTIONS   OF  THE  PROTECTIVE  SOCIAL   MEASURES   STAFF. 

L  Executive  Secretary. 

1.  Autliorized  and  responsible  agent  of  the  boai'tl,  operating  all  of  its  policies 
and  applying  all  of  its  judgments  and  directing  and   coordinating  all   of  the 
several  divisions  under  the  board. 
//.  CMef  of  Division  of  Relations  rvith  States. 

(For  the  present  the  executive  secretary  will  act  as  chief  of  the  Division  of 
Relations  with  States.) 

1.  The  duties  of  the  chief  of  this  division  will  be  to  assist  the  executive  secre- 
tary of  the  board  in  the  operation  of  the  protective  social  measures  program  and 
the  protective  medical  measures  program  of  the  board  in  the  States;  to  assist 
the  executive  secretary  in  the  disbursement  of  the  allotments  from  the  fund  for 
the  assistance  of  the  States  through  their  departments  of  health  for  the  treat- 
ment, prevention,  and  control  of  venereal  diseases  in  accordance  with  the  rules 
established  by  the  Secretary  of  the  Treasury  and  by  the  Interdepartmental 
Social  Hygiene  Board ;  to  check  up  on  the  States  that  may  specifically  appro- 
priate or  otherwise  set  aside  funds  in  order  to  qualify  for  their  allotments 
from  the  Interdepartmental  Social  Hygiene  Board  for  the, use  of  their  respective 
boards  or  departments  of  health  in  the  prevention,  control,  and  treatment  of 
venereal  diseases ;  to  prevent  unnecessary  duplication  of  activities ;  to  coordi- 
nate with  other  similar  activities  the  board  and  the  Government ;  to  operate 
a  system  of  accounting  that  will  safeguard  the  board  and  satisfy  the  Govern- 
ment in  tlie  distribution  of  tiiis  particular  fund  to  the  States. 
///.  Supervising  Assistant  and  Insiyector. 

(a)  Headquarters  in  Washington. 

(&)   Service  in  Washington  with  field  assignments. 

(c)   One  woman,  one  man. 

id)  Functions — 

1.  Responsible  to  the  chief  of  the  Division  of  Relations  with  States  and 
through  that  officer  to  the  executive  secretary,  for  an  intimate,  intelligent,  and 
safe  judgment-forming  knowledge  of  the  need  for,  the  operation  of,  and  the 
effect  of,  a  protective  social  measures  program  in  all  of  its  impoitant  details  in 
all  those  parts  of  the  United  States  in  which  there,  are  soldiers  or  sailors  and 
in  which  there  are  agents  of  the  board. 

This  general  statement  involves  the  whole  functional  organization  of  the  Pro- 
tective Social  Measures  Section  of  the  Division  of  Relations  with  States. 

2.  Responsible  for  the  selection  and  recommendation  of  efficient  dependable 
personnel  for  service  in  tlie  central  office  and  in  the  field. 

3.  To  be  the  sources  of  instruction  to  the  personnel  assigned  for  protective 
social  measures  service  under  their  direction  in  the  central  oflice  or  in  the  field. 
This  insti'uction  should  prepare  each  new  appointee  for  the  duties  of  his  posi- 
tion and  should  bring  to  the  old  appointee  important  information  and  instruc- 
tion whenever  necessary. 

4.  To  recommend  assignments  of  agents  for  service  in  the  fi.eld  and  supervis- 
ing assistants  for  local,  regional,  or  general  assignments., 

203 


204      EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

5.  Responsible  for  an  accurate  judgment  of  the  service  value  of  each  ap- 
pointee under  his  supervision,  directly  or  indirectly  by  way  of  a  State  depart- 
ment of  health.  Retirement  for  good  and  sufficient  reasons  should  be  swift  and 
certain. 

6.  Responsible  for  recommendations  as  to  transfers  of  agents  from  one  assign- 
ment to  another,  especially  in  case  of  possible  dissatisfaction  between  the  agent 
of  the  board  and  the  health  officer  to  whom  that  agent  has  been  assigned. 

7.  To  maintain  records  of  individual  field  service,  safeguarding  our  agents 
from  unmerited  criticism  and  enabling  us  to  anticipate  merited  criticism  and 
forestall  its  appearance. 

8.  The  woman  supervising  assistant  and  inspector  is  responsible  for  the  com- 
pleteness, sociologic  standard,  and  practicality  of  case  records,  both  as  to  form 
and  content. 

Both  supervising  assistants  are  responsible  for  the  form,  content,  and  utility 
of  the  statistical  and  other  records  that  are  required  from  the  field  service  and 
for  the  regular  delivery  of  such  reports  to  the  central  office. 

These  responsibilities  involve  an  important  relationship  with  the  division  of 
records,  information,  and  planning. 

9.  To  maintain  for  the  board  a  directing,  dominating  relationship  to  the  local 
program,  its  organization,  operation,  and  effect,  when  that  local  program  is 
directly  under  the  board.  The  degree  of  local  autonomy  justified  mider  war 
conditions  is  not  justified  under  peace  conditions.  Either  the  board  or  the 
State  departments  of  health  must  be  responsible  for  the  important  and  major 
features  of  each  "  local  "  program. 

10.  To  maintain  an  effective  advisory  relationship  with  tlie  protective  social 
measures  program  through  the  State  department  of  health  in  those  States  in 
which  personnel  has  been  assigned  to  the  State  department  of  health.  In  this 
relationship  there  is  need  for  tact,  diplomacy,  and  vision.  The  supervising 
assistant  must  be  a  good  "  sales  agent." 

11.  To  inform  the  division  chief  regularly  and  concisely  concerning  the  prob- 
lems, facts,  and  activities  associated  with  the  protective  social  measures 
program. 

12.  To  maintain  an  up-to-date  record  and  forecast  of  programs  in  operation 
in  and  proposed  for  each  locality  to  which  agents  of  the  board  are  sent  or  to 
which  they  are  about  to  be  sent. 

13.  To  maintain  a  uniform,  discriminating,  and  stimulating  relationship  with 
the  local  field  service  through  agents  sent  out  from  this  office,  through  assign- 
ments to  this  office  from  the  field  or  through  conference,  and  through  personal 
visits  to  the  field.  This  relationship  should  achieve  satisfying  explanation  of 
our  policies  and  the  work  of  the  board  and  should  give  opportunity  for  answer 
to  the  innumerable  practical  questions  with  which  these  earnest  and  unselfish 
workers  in  the  field  are  concerned — some  of  them  operating  at  long  range  from 
Washington. 

14.  The  supervising  assistants  are  responsible  for  the  letters  and  other  com- 
munications sent  out  by  them  personally  or  sent  out  by  the  central  office  per- 
sonnel working  for  them.  Such  communications  should  always  carry  tlie  sig- 
nature of  the  supervising  assistant  for  whom  they  are  issued,  except  on  occa- 
sions of  absence  of  the  supervisor  from  the  central  office. 

15.  To  recommend  to  the  division  chief,  and  through  the  division  chief  to  the 
executive  secretary,  methods,  machinery,  and  programs  whereby  the  functions 
outlined  above  may  be  performed  practically,  economically,  and  effectively,  and 
whereby  concise  and  accurate  records  luay  be  compiled  covering  these  functions 
and  their  products. 


rp:port  u.  s.  interdepartmental  social  hygiene  board,    g-05 

IV.  Field  supervisor. 

(a)   Headquarters  in  Washington  or  in  tlie  field. 

(&)   Service  entirely  in  tlie  field. 
,    (c)   StnfT  composed  of  women  and  men. 

(d)  Functions  and  regulations  of  field  supervisors  are: 

1.  To  be  intimately  acquainted  with  all  report  blanks,  case-record  foi-ms, 
statistical  forms,  expense-account  records,  and  other  forms  that  are  developed 
under  the  protective  social  measures  program  of  the  board. 

2.  To  be  thoroughly  informed  as  to  the  functions  of  each  and  every  office 
under  the  board. 

3.  To  know  personally  every  officer  and  agent  of  the  board  directly  related 
to  his  or  her  work. 

4.  Should  know  personally  every  officer  in  the  various  other  official  organi- 
zations whose  work  is  directly  related  to  his  or  her  services. 

5.  To  be  informed  up  to  date  concerning  all  reports,  records,  and  statistical 
information  bearing  on  affairs  in  his  or  her  region,  and  also  in  general  relation  to 
the  whole  field. 

6.  To  be  informed  concerning  laws  and  ordinances  relative  to  protective  social 
measures  and  venereal  disease,  especially  in  his  or  her  own  region,  and  to  under- 
stand their  limitations  and  possibilities. 

7.  To  keep  in  close  touch  with  all  records  secured  in  his  or  her  region  and 
particularly  the  use  made  of  and  results  accomplished  by  evidence  or  information 
turned  over  to  law-enforcing  agencies  in  that  region. 

8.  To  be  informed  up  to  date  as  to  (1)  general  vice  and  venereal  disease  con- 
ditions in  his  or  her  territory ;  (2)  the  enforcement  of  laws  for  the  repression  of 
prostitution;  (3)  enforcement  of  antivenereal  disease  laws,  ordinances,  or  regu- 
lations ;  and  to  use  proper  methods  to  secure  better  law  enforcement  when  neces- 
sary, and  to  otherwise  correct  unsatisfactory  conditions. 

9.  To  understand  the  local  State  or  other  local  variations  in  the  protective 
social  measures  program  of  the  board,  especially  those  variations  for  which 
the  chief  State  health  officer  is  responsible. 

10.  To  be  informed  concerning  the  agreements  that  have  been  drawn  up  be- 
tween the  State  health  officer  and  the  board  so  as  to  advise  the  executive  secre- 
tary as  to  their  satisfaction. 

11.  To  make  every  reasonable  and  proper  effort  to  secure  and  maintain  an 
effective  working  relationship  between  the  State  health  officer  and  all  other 
agencies  on  which  the  local  success  of  the  protective  social  measures  program  of 
the  board  depends. 

12.  To  prepare  plans  for  the  executive  secretary  whereby  cooperative  com- 
munity forces  may  be  marshaled,  if  occasion  demands,  for  the  support  of  the 
chief  State  health  officer  and  the  Interdepartmental  Social  Hygiene  Board  in 
their  plans  for  securing  enforcement  of  State  and  local  laws  and  ordinances 
relative  to  the  prevention  and  control  of  venereal  diseases. 

13.  To  formulate  safe  judgments  as  to  the  need  for  new  State  and  local  laws 
and  ordinances ;  new  or  larger  or  improved  reformatory,  detention  house,  and 
other  institutional  accommodations  that  are  or  ought  to  be  available  for  the 
care  of  civilian  persons  who  are  detained  or  committed  therein  for  the  protection 
of  soldiers  and  sailors  from  venereal  diseases,  and  to  stimulate  necessary  legis- 
lation and  needed  improvement  in  institutions  or  establishment  of  new  institu- 
tions. 

14.  To  become  expertly  informed  as  to  reformatories,  detention  houses,  and 
other  institutions  to  which  venereal-disease  carriers  may  be  sent  for  the  pro- 
tection of  soldiers  or  sailors,  keeping  in  mind  the  construction  regulations,  pro- 


206      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

grams  of  information,  instruction,  training,  vocational  opportunities,  hygienic 
and  recreational  opportunities,  treatment  of  venereal  diseases,  and  other  health 
supervisory  and  disciplinary  policies  for  the  successful  care  and  final  social  and 
economic  restoration  of  their  inmates;  and  to  stimulate  needed  improvements. 

15.  To  become  expertly  informed  as  to  State  or  local  need  for  institutions  for 
the  care  of  subnormal  venereal-disease  carriers,  the  hygiene  of  those  institutions, 
the  care  of  the  inmates,  their  regulations  and  their  support,  and  to  stimulate  the 
establishment  of  such  as  are  lacking. 

16.  To  exercise  careful  and  judicious  supervision  over  the  activities  of  those 
agents  of  the  board  properly  under  his  or  her  direction,  transmitting  to  them 
instructions  from  headquarters  and  giving  them  necessary  directions,  counsel, 
and  assistance  as  occasion  demands  for  an  effective  functioning  of  the  protective 
social-measures  program. 

17.  To  render  accurate,  systematic,  periodical  reports  to  the  board  as 
directed. 

18.  To  act  as  hi w-en forcing  officer  only  when  properly  appointed  by  com- 
petent authority  and  after  such  appointment  has  been  approved  by  the  executive 
secretary. 

19.  In  submitting  to  law-enforcement  agencies  information  as  to  prostitution 
or  other  related  unsatisfactory  community  social  condition,  or  in  recommending 
to  the  proper  agency  a  needed  improvement  in  institutions  for  care  and  treat- 
ment of  venereal-disease  carriers,  or  for  new  institutions,  or  in  other  simifar 
matters  of  recorjmendation  or  stimulation,  it  is  essential  that  inquiry  first  be 
made  as  to  whether  or  not  such  information,  recommendation,  or  stimulation 
has  been  previously  used  or  submitted  by  an  agent  of  the  board,  and  if  so,  what 
resulted  tlierefrom ;  this  regulation  is  designed  to  pi'event  duplication  of  efifort 
and  to  emphasize  necessity  for  closer  cooperation  between  the  board's  agents 
iks  well  as  to  prevent  needless  repetition  to  or  "  nagging  "  of  official  agencies. 

r.  linpervisor  or  field  agent  in  chary e: 

(a)  Headquarters  in  che  field  under  the  State  department  of  health  or  in  a 
city,  a  community,  or  "  region." 

(?))  Service  entirely  in  the  field. 

(r)   Staff  composed  of  women  and  men. 

(d)  Functions  and  regulations  of  supervisor  or  field  agent  in  charge  are: 

1.  To  be  intimately  acquainted  with  all  report  blanks,  case  record  forms, 
statistical  forms,  expense  account  records,  and  other  forms  that  are  developed 
under  the  protective  social  measures  program  of  the  board. 

2.  To  be  thoroughly  informed  as  to  functions  of  each  and  every  officer  under 
the  board. 

3.  To  know  personally  every  agent  or  supervisor  of  the  board  directly  related 
to  his  or  her  work. 

4.  To  know^  personally  every  officer  in  the  various  other  oflicial  organizations 
in  his  or  her  region  whose  work  is  directly  related  to  his  or  her  services. 

5.  To  be  informed  up  to  date  concerning  all  reports,  records,  and  statistical 
information  bearing  on  affairs  in  his  or  her  region  and  also  in  general  relation 
to  th^  whole  field. 

6.  To  be  thoroughly  informed  concerning  laws  and  ordinances  relative  to 
protective  social  measures  and  venereal  disease  in  his  or  her  region  and  also 
understand  their  limitations  and  possibilities. 

7.  To  use  every  available  means  for  securing  information  relative  to  the  foci 
of  venei'eal-disease  infection  personally  and  through  his  or  her  subordinates. 
To  be  responsible  for  submitting  this  information  to  the  proper  law-enforcing 
jigency  with  such  stinuilatory  action  as  may  be  necessary :  and  for  a  careful 
observation  of  action  taken  thereon  and  results  accomplished. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     207 

8.  To  constantly  endeavor  to  discover  oi-  Identify  venereal  disease  carriers 
through  (1)  reports  from  representatives  of  the  board;  (2)  i-eports  from 
venereai  clinics  or  other  agencies;  (3)  information  secured  from  police  cases, 
and  (4)  personal  contact  with  such  individuals;  and  to  make  report  thereof  to. 
proper  health  authorities. 

9.  To  constantly  search  for  information  relative  to  use  made  of  facts  and 
data  submitted  to  law  enforcement  agencies  and  for  evidence  as  to  enforcement 
of  antivenereal-disease  laws  and  ordinances. 

10.  To  observe  the  conduct  of  persons  after  treatment  as  venei-eal  disease 
carriers  to  ascertain  whether  or  not  they  have  ceased  to  practice  prostitution, 
with  such  subsequent  action  as  appears  necessai'y. 

11.  To  be  informed  regarding  the  agreements  that  have  been  entered  into, 
between  the  chief  State  health  offlcer  and  the  Interdepartmental  Social  Hygiene. 
Board  (if  assigned  to  a  State  department  of  health)  and  lend  all  possible, 
assistance  in  the  fulfillment  of  the  conditions  thereof. 

12.  To  make  every  reasonable  and  proper  effort  to  secure  and  maintain  aa 
effective  working  i-elationship  between  the  State  health  officer  and  all  other 
agencies  on  which  the  local  success  of  the  protective  social  measures  progran) 
of  the  board  depends. 

13.  To  devise  plans  and  means  whereby  cooperative  community  forces  may. 
be  marslialed  for  the  support  of  the  cliief  health  ofiicer  and  the  Interdepart- 
mental Social  Hygiene  Board  in  their  plans  for  securing  enforcement  of  State 
and  local  laws  and  ordinances  relative  to  the  prevention  and  control  of  venereal^ 
diseases. 

14.  To  formulate  safe  judgments  as  to  the  need  for  new  State  and  local  lawa 
aud  ordinances ;  new  or  larger  or  improved  reformatory,  detention  house,  and 
other  institutional  accommodations  that  are  or  ought  to  be  availal^le  for  the 
care  of  civilian  persons  who  are  detained  therein  for  the  protection  of  soldiersi 
and  sailors  from  venereal  disease,  and  to  stimulate  needed  improvement  in  in-. 
stitutions  or  establishment  of  new  institutions. 

15.  To  become  thoroughly  informed  as  to  reformatories,  detention  houses, 
and  other  institutions  to  which  venereal-disease  carriers  may  be  sent  for  the, 
protection  of  soldiers  and  sailors,  as  regards  :  (1)  Construction  ;  (2)  regulatiojis  :. 
(3)  programs  of  information,  instruction,  and  training;  (4)  vocational  op- 
portunities; (.5)  hygienic  and  i*ecreational  opportunities;  (6)  treatment  for. 
venereal  diseases ;  and  other  health  supervision  and  disciplinary  policies  for 
the  successfid  care  and  final  social  and  economic  i*estoration  of  their  inmates — 
and  to  stimulate  needed  improvemests. 

16.  To  become  well  informed  as  to  State  or  local  need  for  institutions  for. 
the  care  of  subnormal  venereal-disease  carriers,  the  hygiene  of  Ijhese  institu- 
tions, the  care  of  their  inmates,  their  regulations  and  their  support,  and  to, 
stimulate  the  establishment  of  such  as  are  lacking. 

17.  To  exercise  careful  and  judicious  supervision  over  the  activities  of  those 
agents  of  the  board  properly  under  his  or  her  direction,  transmitting  to  them, 
instructions  from  headquarters  and  giving  them  necessary  directions,  counsel, 
and  assistance  as  occasion  demamls  for  an  effective  finictioning  of  the  protec- 
tive social  measures  program. 

IS.  To  render  accurate,  systematic,  periodical  reports  as  directed. 

19.  To  act  as  law-enforcement  officer  only  when  properly  appohited  by  com]je-. 
tent  authority  and  such  appointment  has  been  approved  by  the  executive  secre- 
tary. 

20.  In  snbnntting  to  law-enforcement  agencies  infoi'mation  us  to  prostitu-, 
tion  or  other  related  unsatisfactory  connnunity.  social  conditions,  or  in  recom- 
mending to  the  proper  agency  a  ne<>de(l   iiiiprovcMnont  in  institutions  for  care. 


208      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

and  treatment  of  venereal -disease  carriers,  or  for  new  institutions,  or  in  otlier 
similar  matters  of  recommendation  or  stimulation,  it  is  essential  that  inquiry 
first  be  made  as  to  whether  or  not  such  information,  recommendation,  or  stimu- 
lation has  been  previovisly  used  or  submitted  by  an  agent  of  the  board,  and  if 
so,  what  resulted  therefrom ;  this  regulation  is  designed  to  prevent  duplication 
of  effort  and  emphasize  necessity  for  closer  cooperation  between  the  boai'd's 
agents  as  well  as  to  prevent  needless  repetition  to  or  "  nagging "  of  official 
agencies. 

21.  All  agents  of  the  board  assigned  to  a  bureau  of  protective  social  measuras 
under  a  State  department  of  health  are  to  receive  instructions  from  and  be 
responsible  to  the  chief  State  health  officer.  It  is  believed  that  such  direction? 
will  follow  closely  the  directions  set  forth  here  and  that  little  if  any  incompati- 
bility will  result. 

22.  Special  service — Woman  supervisor  or  field  agent  in  charge. 

(a)  To  maintain  close  contact  with  case  work  of  each  agent  under  her  direc- 
tion and  do  or  cause  to  be  done  necessary  follow-up  work. 

(b)  To  place  a  competent  male  agent  in  charge  of  law-enforcement  work. 

(c)  To  organize  local  committees  designed  to  stimulate  protective  social  work 
with  women  and  girls,  either  personally  or  through  subordinate  agents. 

(d)  To  place  a  competent  woman  in  direct  charge  of  all  case  work  with 
women  and  girls. 

23.  Special  service — Man  supervisor  or  field  agent  in  charge. 

(a)  Discovery  or  identification  of  houses  of  prostitution  and  other  premises 
where  prostitution  occurs ;  observation  of  burlesque  theaters  and  taxicab  prac- 
tices which  make  for  the  spread  of  venereal  diseases,  and  turning  over  all 
such  information  to  regularly  constituted  law-enforcing  agencies  for  official 
action  and  careful  observation  of  action  taken  thereon  aad  results  thereof. 

(b)  To  place  a  competent  woman  agent  in  direct  supervision  of  all  case  work 
with  women  and  girls. 

(c)  Organization  of  local  committee  for  stimulation  of  law  enfoi'cement. 
(This  may  be  a  joint  committee  with  the  one  designed  to  stimulate  protective 
social  work  or  may  be  an  organization  already  existing  which  will  assume  re- 
sponsibility for  such  community  activity.) 

VI.  Field  Agents. 

(a)  Located  wherever  assigned  by — ■ 

1.  State  health  officer. 

2.  Interdepartmental  Social  Hygiene  Board,  executive  secretary. 

(b)  Service  entirely  in   the  field. 

(c)  Staff  composed  of  women  and  men. 

(d)  Functions  and  regulations  of  field  agents  are: 

1.  To  be  intimately  acquainted  with  all  report  blanks,  case  record  forms, 
statistical  forms,  expense  accoinit  records,  and  other  forms  that  are  developed 
under  the  protective  social  measures  program  of  the  board. 

2.  To  contact  and  establish  cooperative  working  relations  with  all  public 
officials  in  his  or  her  region  who  are  factors  in  an  effective  program  of  protec- 
tive social  measures,  and  explain  to  each  the  salient  features  of  the  program  of 
protective  social  measures. 

3.  To  be  informed  up  to  date  concerning  all  reports,  records,  and  statistical 
information  bearing  on  affairs  in  his  or  her  region  and  also  in  general  relation 
to  the  field. 

4.  To  be  thoroughly  informed  concerning  laws  and  ordinances  relative  to  pro- 
tective social  measures  and  venereal  diseases  in  his  or  her  region  and  under- 
stand their  limitations  and  possibilities. 


REPORT  U.  S.  INTERDEPARTMENTAL.  SOCIAL  HYGIENE  BOARD.     209 

5.  To  procure  information  as  to  the  existence  of  prostitution  and  deliver  same 
to  tlie  regularly  constituted  law  enforcing  agencies  and  observe  action  taken 
thereon  and  results  thereof.  It  is  primarily  the  duty  of  the  field  agents  to 
stimulate  law  enforcement  through  contact  with  law  enforcing  agencies  and  at- 
tendance in  courts  where  matters  of  importance  in  the  protective  social  measures 
program  are  determined. 

6.  To  make  frequent  observation  of  places  of  public  recreation,  amusement, 
or  congregation  which  may  carry  programs  of  prostitution  and  seek  to  correct 
any  bad  conditions  noted,  through  official  agencies  charged  witli  that  duty. 

7.  To  constantly  endeavor  to  discover  or  identify  venereal  disease  carriers 
through  (1)  reports  of  representatives  of  the  board;  (2)  reports  from  venereal 
clinics  or  other  agencies;  (3)  information  secured  from  police  cases;  and  (4) 
personal  contact  with  such  individuals — and  to  make  report  thereof  to  proper 
health  authorities. 

8.  To  constantly  search  for  information  relative  to  use  made  of  facts  and  data 
submitted  to  law-enforcing  agencies  and  for  evidence  as  to  enforcement  of 
antivenereal  disease  laws  and  ordinances. 

9.  To  observe  the  conduct  of  persons  after  treatment  as  venereal-disease  car- 
riers to  ascertain  whether  or  not  they  have  ceased  to  be  venereaVdisease  carriers 
and  whether  or  not  they  have  ceased  to  practice  prostitution,  with  such  subse- 
quent action  as  appears  necessary. 

10.  To  ascertain  effective  means  for  using  cooperative  community  forces  for 
law  enforcement  and  bring  such  forces  into  action. 

11.  To  become  well  informed  as  to  need  for  facilities  for  treatment  and  de- 
tention of  venereal-disease  carriers  and  foster  official  action  to  provide  such 
facilities. 

12.  To  receive  directions  from  directors,  supervisors,  or  other  agents  of  the 
board  who  have  been  properly  designated  as  supervisors  and  carefully  carry 
out  such  directions  or  act  upon  suggestions  given. 

13.  In  submitting  to  law  enforcing-agencies  information  as  to  prostitution 
or  other  related  unsatisfactory  community  social  conditions,  or  in  recommend- 
ing to  the  proper  agency  a  needed  improvement  in  institutions  for  care  and  treat- 
ment of  venereal-disease  carriers,  or  for  new  institutions,  or  in  other  similar 
matters  of  recommendation  or  stimulation,  it  is  essential  that  inquiry  first  be 
made  as  to  whether  or  not  such  information,  recommendation,  or  stimulation 
has  been  previously  used  or  submitted  by  an  agent  of  the  board,  and  if  so, 
what  resulted  therefrom ;  this  regulation  is  designed  to  prevent  duplication  of 
effort  and  emphasize  necessity  for  closer  cooperation  between  the  board's  agents 
as  well  as  to  prevent  needless  repetition  to  or  "nagging"  of  official  agencies. 

14.  All  agents  of  the  board  assigned  to  a  Bureau  of  Protective  Social  Meas- 
ures under  a  State  department  of  health  are  to  receive  instructions  from  and 
be  responsible  to  the  chief  State  health  oflScer.  It  is  believed  that  such  directions 
will  follow  closely  the  directions  set  forth  here  and  that  little  if  any  incompati- 
bility will  result. 

15.  To  organize  committees  to  stimulate  law  enforcement  and  protective 
social  work  with  women  and  girls. 

16.  Special  Service — Women  agents. 

(a)  All  investigation,  inquiry,  and  research  relative  to  case  work  with  women 
and  girls,  including  endeavors  to  have  physical  and  mental  examinations  made 
in  each  case  and  to  make  recommendations  to  courts  or  other  official  or  unofficial 
agencies  relative  to  the  final  disposition  of  each  case,  and  follow-up  work  with 
such  cases. 

(b)  To  turn  over  to  male  agents  or  directly  to  law-enforcing  agencies  In- 
formation relative  to  existence  of  houses  of  prostitution. 

15610—20 14 


210     EEPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL,  HYGIENE  BOARD. 

17.  Special  Service — Men  agents. 

(a)  To  discover  houses  of  prostitution  or  places  where  prostitution  occurs, 
also  the  existence  of  programs  of  prostitution,  and  turn  over  all  such  informa- 
tion to  law-enforcing  agencies  or  other  official  agencies  directly  concerned  for 
official  action.     The  results  must  be  carefully  observed. 
YII.  Assistant  Field  Agefits. 
VIII.  Assistant  Special  Agents. 

Same  in  all  respects  as  field  agent  except  that  all  assistant  agents  when  work- 
ing under  directions  of  other  agents  of  the  board  shall  take  directions  from 
such  agent.  When  an  assistant  agent  is  placed  in  charge  of  a  station  without 
an  immediate  superior  at  that  station,  he  or  she  will  perform  duties  and  be  sub- 
ject to  the  same  requirements  as  those  enumerated  for  field  agents. 
iX.  Confidential  Protective  Social  Agents. 

(a)  Located  wherever  assigned  by  executive  secretary. 

(&)   Staff  entirely  in  the  field. 

(c)  Staff  composed  of  men  and  women. 

(d)  Functions  and  requirements. 

1.  To  make  confidential  investigations  of  vice  conditions. 

2.  To  render  confidential  reports  to  the  executive  secretary  immediately  upon 
completion  of  an  investigation  as  directed. 

3.  No  difference  between  service  of  men  and  women. 

The  protective  social-measures  program  contemplates  no  discrimination  be- 
tween male  and  female  prostitutes.  All  agents  of  the  board  are  cautioned, 
therefore,  against  the  somewhat  prevalent  policy  of  exempting  men  from  the 
•  operation  of  laws,  ordinances,  or  regulations  designed  to  prevent  the  spread 
of  venereal  diseases. 

A  wise  and  effective  application  of  the  protective  social-measures  program  in- 
volves a  thorough  understanding  not  only  of  the  essentials  of  the  program,  but 
of  the  varying  shades  of  distinction  between  certain  of  its  features.  It  appears 
that  the  lines  of  demarcation  between  disease,  crime,  and  immorality  have  given 
rise  to  the  greatest  confusion. 

Crime  may  be  defined  as  the  commission  (or  omission)  of  an  act  specifically 
forbidden  (or  enjoined)  by  public  law  and  whereby  the  offender  becomes  liable 
to  punishment  in  a  court  of  justice.  Arrest,  trial,  conviction  (or  acquittal),  and 
sentence  are  terms  which  apply  only  to  crime  or  criminals. 

Disease  is  the  antithesis  of  health ;  it  may  be  briefly  and  simply  defined  as  a 
morbid  condition  resulting  from  disturbance  or  failure  of  natural  physiological 
functions.  Diseases  which  are  so  communicable  as  to  be  a  menace  to  the  public 
health  are  usually  controlled  by  quarantine  of  the  persons  so  diseased.  The 
public  health  authorities  only  are  vested  with  the  power  of  quarantine.  The 
fact  that  many  persons  contract  disease  because  of  abuses,  intemperance,  ex- 
cesses, indulgences,  or  other  acts  which  may  be  classed  as  crimes,  does  not  make 
It  a  crime  to  have  the  disease.  No  person  falls  into  the  criminal  category  be- 
cause he  has  become  a  victim  of  a  disease,  however  loathsome.  A  person  may 
commit  a  crime  and  through  the  commission  of  that  crime  also  contract  a  loath- 
some communicable  disease ;  but  the  remedy  for  the  crime  is  one  to  be  applied 
by  a  court  of  justice,  while  the  community  looks  to  public  health  officials  for  its 
protection  against  the  disease.  Venereal  disease  is  a  typical  example.  Much 
venereal  disease  is  spread  through  prostitution ;  prostitution  is  a  crime  in  every 
State  in  the  United  States  excepting  two;  hence  many  venereal  carriers  will 
also  be  criminals.  However,  venereal  disease  may  be  and  frequently  is  con- 
tracted innocently;  hence  not  all  venereally-diseased  persons  are  or  have  been 
criminals. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     211 

Thus  is  emphasized  the  necessity  for  divorcing  the  disease  features  of  the 
protective  social  measures  program  from  its  law  enforcement  features.  The 
function  of  the  police  department  and  the  courts  and  those  of  health  depart- 
ments are  separate  and  distinct,  and  it  is  important  that  the  board's  agents 
clearly  recognize  the  distinction. 

Immorality  is  a  condition  of  being  immoral ;  any  person  who  does  an  act  in- 
consistent with  moral  rectitude  or  violates  any  moral  or  divine  law  may  be 
classed  as  immoral.  It  is  a  broad  term  and  covers  not  only  several  classes  of 
crimes,  but  a  multitude  of  other  acts  which  depend  for  their  moral  sanction 
ajwii  the  person's  conscience  or  public  opinion.  Many  crimes  involve  immorality, 
but  ijnmorality  is  not  always  crime.  The  Interdepartmental  Social  Hygiene 
Board  is  concerned  with  Immorality  in  so  far  as  it  may  be  a  factor  in  the  spread 
cf  venereal  disease  to  members  of  the  Army  or  Navy.  The  board  does  not  de- 
preciate the  importance  of  the  moral  phase  of  the  social  hygiene  movement,  but 
in  conformity  with  the  act  of  Congress  establishing  the  board  and  outlining  its 
responsibilities  the  protective  social  measures  program  is  confined  rather  closely 
to  measures  for  protecting  soldiers  and  sailors  from  venereal  infection. 

Thus  it  will  be  apparent  that  the  board's  program  is  vitally  concerned  with 
crime  and  disease  to  the  extent  and  in  the  manner  set  forth  herein,  but  it  is 
essential  that  crime  and  disease  be  considered  as  separate  and  distinct  features 
of  the  protective  social  measures  program. 

Owing  to  the  fact  that  tlie  general  publid  places  a  stigma  upon  any  person 
with  a  venereal  disease  no  publicity  more  than  is  absolutely  necessary  should 
be  given  in  any  case.  Communications  or  conferences  with  public  officials 
directly  concerned  in  the  matter  do  not  constitute  publicity,  however.  Much 
greater  circumspection  is  necessary  in  cases  of  persons  only  suspected  of  being 
venereal  disease#?arriers  lest  the  suspicion  be  a  mistaken  one  and  the  person 
subjected  to  annoyance  and  embarrassment.  Publicity  should  also  be  avoided 
as  much  as  possible  in  dealing  with  first  offenders  and  unhardened  prostitutes. 
Public  ridicule  or  censure  may  very  seriously  deter  the  reclamation  of  such 
persons  by  destroying  the  last  vestige  of  pride  or  self-respect  they  may  have. 

T.  A.  Stokey, 
Executive  Secretary, 
Irti&~d:eftm^memtal  Social  Hygiene  Board. 

2.  FORM  OF  PROPOSAL  FOR  GOVERNMENTAL  ASSISTANCE  IN 
THE  ORGANIZATION  OF  BUREAUS  OF  PROTECTIVE  SOCIAL 
MEASURES  IN  STATE  DEPARTMENTS  OF  HEALTH. 

In  conformity  with  the  provisions  carried  by  sections  2  and  5  of  Chapter  XV, 
Public  193,  Sixty-fifth  Congress,  Army  appropriation  bill,  July  9,  1918,  the 
United  States  Interdepartmental  Social  Hygiene  Board  proposes  to  assist 
those  States  that  contain  permanent  military  and  naval  establishments  by  mak- 
ing allotments  for  the  organization  of  a  division  or  bureau  or  section  of  the 
State  department  of  health  or  other  appropriate  subdivision  of  the  State 
government  of  those  States  which  will  be  concerned  with  the  care  of  civilian 
persons  "  whose  detention,  isolation,  quarantine,  or  commitment  to  institutions 
may  be  found  necessary  for  the  protection  of  the  military  and  naval  forces 
of  the  United  States  against  venereal  diseases." 

The  board  proposes  that  when  these  bureaus  of  protective  social  measures 
are  established  in  State  departments  of  health  the  personnel  assigned  by  the 
board  to  serve  in  such  bureaus  shall  be  approved  by,  directed  by,  and  be 
responsible  to  the  chief  health  officer  of  the  State;  and  the  chief  State  health 
officer  shall  operate  a  program  for  the  prevention  of  venereal  diseases  and 


212      EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

the  consequent  protection  of  the  military  and  naval  forces  of  the  United  States 
satisfactory  to  the  Interdepartmental  Social  Hygiene  Board  and  properly 
correlated  with  all  other  activities  of  the  State  health  organization;  and  that 
the  Interdepartmental  Social  Hygiene  Board  shall  pay  the  salaries  and  trav- 
eling expenses  in  accord  with  standard  Government  regulations,  and  the  State 
department  of  health  will  provide  proper  ofRee  space  and  equipment  of  the 
assigned  personnel  necessary  to  complete  the  organization  of  these  bureaus, 
divisions,  or  sections  of  protective  social  measures  in  the  State  department  of 
health  each  month  up  to  June  30,  1921,  in  accordance  with  the  provisions  of 
the  agreement  made  between  the  chief  health  officer  of  the  State  concerned 
and  the  board. 

In  general  the  board  will  expect  the  chief  State  health  officer  or  other  State 
official  entering  into  this  agreement  to  be  responsible  for  the  operation,  through 
the  Bureau  of  Protective  Social  Measures,  of  a  program  that  will  cover  the 
following  activities : 

(a)  Investigation  of  social  conditions  which  makes  for  the  spread  of  venereal 
disease  and  search  for  foci  of  infection  with  a  view,  to  securing  the  proper 
care  or  detention  of  civilian  persons  infected  with  venereal  disease. 

(&)  Investigation  of  social  influences  that  produce  carriers  of  venereal  dis- 
eases, and  follow-up  work  with  persons  who  have  been  carriers  to  prevent 
them  from  again  subjecting  themselves  to  conditions  which  may  lead  to 
infection. 

(c)  Investigation  of  provisions  and  facilities  for  the  care  and  maintenance 
of  persons  infected  with  venereal  diseases. 

AppLication  to  the  United  States  Interdepartmental  Social  Hygiene  Board  for 
the  assignment  of  personnel  for  service  in  the  division,  section,  or  bureau  of 

protective  social  measures  in  the  department  of  healtli.  State  of  ,  for 

the  year  ending  .Tune  30,  1921 : 

Date  of  application  :  . 

1.  Name  of  State  department  of  health  (or  equivalent  division  of  the  State 
government)  for  which  this  application  is  made:  . 

2.  Name,  official  position  and  address  of  the  chief  State  health  officer  who 
is  the  responsible  and  competent  agent  authorized  to  ]nake  this  application 
and  who  is  making  this  application  for  the  department  of  health  of  the  State 
of  .    ■ 

(a)  Name:   . 


( b )  Official  position  :  . 

(c)  Address:  . 

3.  Locations  of  permanent  or  important  temporary  military  and  naval  forces 
in  this  State  (give  number  of  soldiers  or  sailors  in  each  at  the  time  this 
application  is  made)  :  • . 

4.  Provisions  that  have  already  been  made  in  this  State  department  of  health 
for  the  investigation  of  social  conditions  which  make  for  spread  of  venereal 
disease  and  seai-ch  for  foci  of  infection  with  a  view  of  securing  the  proper  care 
or  detention  of  civilian  persons  infected  or  likely  to  be  infected  with  venereal 
disease :  . 

Additional  provisions  proposed  for  sucli  investigation  and  search :  . 

5.  Provisions  that  have  already  been  made  for  "  Investigation  of  social  in- 
fluences that  produce  carriers  of  venereal  disease  and  follow-up  work  with 
persons  who  have  been  carriers,  to  prevent  them  from  again  subjecting  them- 
selves to  conditions  which  may  lead  to  infection  " :  . 

Additional  provisions  proposed  for  such  investigation  and  follow-up 
work :  . 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     213 

6.  Provisions  tliat  have  already  been  made  for  investigation  of  provisions 
and  facilities  for  the  care  and  maintenance  of  persons  infected  with  venereal 
disease:  . 

Additional  provisions  proposed  for  carrying  out  these  investigations:  . 


7.  Personnel  now  employed  by  this  State  department  of  health  for  the  pur- 
pose outlined  in  paragraphs  4,  5,  and  G  above  (give  concise  statement  of  the 
duties  of  each  of  these  persons)  :  . 

I, ,  the  chief  health  otRcer  of  the  State  of  ,  designated 

above  in  paragraph  2,  hereby  make  application  to  the  United  States  Interde- 
partmental Social  Hygiene  Board  for  the  assignment  of  personnel  to  service 
in  the  bureau  of  protective  social  measures  in  the  department  of  health,  of  the 
State  of  ,  from  June  30,  1920,  until  June  30,  1921,  or  until  this  agree- 
ment is  terminated,  provided  that  this  personnel  be  approved  by,  directed  by, 
and  responsible  to  the  chief  health  officer  of  this  State  during  the  period  under 
which  such  personnel  is  assigned  by  the  board  for  service  in  the  bureau  of 
protective  social  measures  in  this  department  of  health. 

In  my  capacity  as  chief  health  officer  and  responsible  agent  to  the  department 

of  health  of  the  State  of ,  and  by  virtue  of  authority  invested  in  me  by 

the  State  board  of  health,  I  agree  that  I  will,  within  the  limitations  of  my 
power,  "  operate  a  program  for  the  prevention  of  venereal  disease  and  the 
consequent  protection  of  the  military  and  naval  forces  of  the  United  States, 
satisfactory  to  the  United  States  Interdepartmental  Social  Hygiene  Board 
and  properly  correlated  with  all  other  activities  of  the  health  organization  of 
this  State;"  said  program  shall  not  include  any  encouragement,  recognition, 
or  licensing  of  prostitution  or  houses  of  prostitution ;  and  further,  that  I 
will,  to  the  best  of  my  ability,  direct  successfully  and  effectively  the  investi- 
gations and  other  activities  included  in  the  protective  social  measures  program 
of  the  United  States  Interdepartmental  Social  Hygiene  Board,  and  that  reports 
on  each  of  these  activities  will  be  made  to  me  by  the  several  responsible  mem- 
bers of  the  personnel  of  the  bureau  of  protective  social  measures,  copies  of  all 
which  reports  will  be  sent  directly  to  the  United  States  Interdepartmental 
Social  Hygiene  Board  regularly  and  without  delay;  that  I  will  receive  such 
suggestions,  advice,  and  counsel  as  the  Interdepartmental  Social  Hygiene  Board 
may  give,  and  make  the  best  use  of  such  communications  as  my  judgment  dic- 
tates; that  I  will  do  every  reasonable  thing  within  my  power  to  prevent,  con- 
trol, and  eradicate  venereal  diseases  in  this  State  through  protective  social 
measures  as  well  as  through  protective  medical  measures,  and  agree  that  this 
agreement  may  be  terminated  on  30  days'  notice  by  either  party  concerned. 


Chief  State  Health  Officer. 
Approved : 


Executive  Secretary. 


Appendix  D. 

RULES  AND  REGULATIONS  GOVERNING  EXPENDITURES  FROM  THE 
STATE  ALLOTMENTS  OF  THE  CHAMBERLAIN-KAHN  FUNDS. 


APPROPRIATIONS. 


1.  Appropriations  1919  and  1920. — The  Sixty-fifth  Congress  appropriated  the 
sum  of  $1,000,000  for  each  of  the  fiscal  years  1919  and  1920,  to  be  paid  to  the 
various  States  for  the  use  of  their  boards  or  departments  of  health  in  the  pre- 
vention, control,  and  treatment  of  venereal  diseases ;  this  sum  to  be  allotted  to 
each  State  on  the  basis  of  the  1910  population  in  accordance  with  the  rules  and 
I'egulations  of  the  Secretary  of  the  Treasury. 

2.  Chamberlain-EaJm  Act. — This  act  is  known  as  the  Chamberlain-Kahn  Act 
and  constitutes  chapter  15  of  the  "Act  making  appropriations  for  the  support 
of  the  Army  for  the  fiscal  year  ending  June  30,  1919." 

This  act  reads  in  part  as  follows : 

United  States  Interdepartmental  Social  Hygiene  Board :  That  there,  is  hereby 
created  a  board  to  be  known  as  the  United  States  Interdepartmental  Social 
Hygiene  Board,  to  consist  of  the  Secretary  of  War,  the  Secretary  of  the  Navy, 
and  the  Secretary  of  the  Treasury  as  ex  officio  members,  and  of  the  Surgeon 
General  of  the  Army,  the  Surgeon  General  of  the  Public  Health  Service,  or  of 
representatives  designated  by  the  Secretary  of  War,  the  Secretary  of  the  Navy, 
and  the  Secretary  of  the  Treasury,  respectively. 

*  *  *  That  there  is  hereby  appropriated  out  of  any  moneys  in  the  Treasury 
not  otherwise  appropriated  *  *  *  the.  sum  of  $1,000,000,  which  shall  be 
paid  to  the  States  for  the  use  of  their  respective  boards  or  departments  of  healtli 
in  the  prevention,  control,  and  treatment  of  venereal  diseases ;  this  sum  to  be 
allotted  to  each  State,  in  accordance  with  the  rules  and  regulations  prescribed 
by  the  Secretary  of  the  Treasury  in  the  proportion  which  its  population  bears 
to  the  population  of  the  continental  United  States,  exclusive  of  Alaska  and 
the  Canal  Zone,  according  to  the  last  preceding  United  States  census,  and  such 
allotment  to  be  so  conditioned  that  for  each  dollar  paid  to  any  State  the  State 
shall  specifically  appropriate  or  otherwise  set  aside  an  equal  amount  for  the 
prevention,  control,  and  treatment  of  venereal  diseases,  except  for  the  fiscal 
year  ending  June  30,  1919,  for  which  the  allotment  of  money  is  not  conditioned 
upon  the  appropriation  or  setting  aside  of  money  by  the  State,  provided  that  any 
State  may  obtain  any  part  of  its  allotment  for  any  fiscal  year  subsequent  to 
June  30,  1919,  by  specifically  appropriating  or  otherwise  setting  aside  an  amount 
equal  to  such  part  of  its  allotment  for  the  prevention,  control,  and  treatment  of 
venereal  diseases. 

3.  Rules  and  regulations  of  the  Secretary  of  the  Treasury. — Under  date  of 
September  4,  1918,  the  Secretary  of  the  Treasury  promulgated  rules  and  regu- 
lations which  provided  that  State  allotments  shall  be  expended  along  general 
standard  lines  for  all  States  and  in  accordance  with  an  accounting  system  to  bo 
forwarded    by    the    United    States    Interdepartmental    Social    Hygiene    Board. 

214 


REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD.     215 

Hence  the  regulations  of  this  board  governing  these  expenditures  are  given  the 
effect  of  law. 

These  regulations  of  the  Secretary  of  the  Treasury  are  as  follows : 

REGULATIONS. 

Promulgated  by  the  Secretary  of  the  Treasury,  under  which  State  boards  or  State 
departments  of  health  receive  the  allotment  of  funds  provided  in  section  6, 
chapter  15,  of  the  act  approved  .July  9,  entitled  "An  act  making  appropria- 
tions for  the  support  of  the  Army  for  the  fiscal  year  ending  June  30,  1919." 
The  act  provides  that  $1,000,000  shall  be  distributed  to  the  States  for  the  use 
of  their  respective  boards  or  departments  of  health  in  the  prevention,  control, 
and  treatment  of  venereal  diseases,  this  sum  to  be  allotted  to  each  State,  in 
accordance  with  rules  and  regulations  prescribed  by  the  Secretary  of  the  Treas- 
ury,  in  the  proportion  which  its  population  bears  to  the  population  of  the 
continental  United  States,  exclusive  of  Alaska  and  the  Canal  Zone,  according  to 
the  last  preceding  United  States  census. 

State  boards  or  departments  of  health  receiving  their  respective  allotments 
shall  agree  to  the  following  cooperative  measures  under  which  their  appropria- 
tion shall  be  expended : 

1.  Put  into  operation,  through  a  legislative  enactment  or  a  State  board  of 
health  regulation  having  the  effect  of  law.  regulations  in  conformity  with  the 
suggestions  approved  by  the  Surgeons  General  of  the  Army,  Navy,  and  United 
States  Public  Health  Service,  for  the  prevention  of  venereal  diseases.  The 
minimum  requirements  of  these  rules  are : 

(a)  Venereal  diseases  must  be  reported  to  the  local  health  authorities  in  ac- 
cordance with  State  regulations  approved  by  the  United  States  Public  Health 
Service. 

( b )  Penalty  to  be  imposed  upon  physicians  or  others  required  to  report  vene- 
real infections  for  failure  to  do  so. 

(c)  Cases  to  be  investigated,  so  far  as  practicable,  to  discover  and  control 
sources  of  infection. 

(d)  The  spread  of  venereal  diseases  should  be  declared  unlawful. 

(e)  Provision  to  be  made  for  control  of  infected  persons  that  do  not  cooperate 
in  protecting  others  from  infection. 

(f)  The  travel  of  venereally  infected  persons  within  the  State  to  be  controlled 
by  State  boards  of  health  by  definite  regulations  that  will  conform  in  general  to 
the  interstate  regulations  to  be  established. 

(g)  Patients  to  be  given  a  printed  circular  of  instructions  informing  them  of 
the  necessity  of  measures  to  prevent  the  spread  of  infection  and  of  the  impor- 
tance of  continuing  treatment. 

2.  An  officer  of  the  Public  Health  Service  shall  be  assigned  to  each  State 
receiving  allotments  for  the  general  purpose  of  cooperating  with  the  State  health 
officer  in  supervising  the  venereal-control  work  in  the  State.  This  officer  to  be 
selected  by  the  State  health  authorities  and  to  be  approved  and  recommended 
for  appointment  by  the  Surgeon  General  of  the  Public  Health  Service.  Tlie 
salary  of  this  oflicer  will  be  paid  by  the  State  out  of  the  funds  made  availabiS 
from  the  allotment,  except  a  nominal  sum  of  $10  per  month,  which  will  be  paid 
by  the  United  States  Public  Health  Service.  In  those  States  where  a  bureau  of 
venereal  diseases  has  already  been  established,  with  a  full-time  medical  oflicer 
in  charge,  the  present  incumbent  may  be  recommended  for  appointment  by  the 
State  health  officer,  and,  with  the  approval  of  the  Surgeon  (;<nieral,  United 
States  Public  Health  Service,  he  will  be  appoint^^d  as  aa  officer  of  the  Public 


216      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD. 

Health  Service.  The  general  plan  of  work  for  the  State  bureau  of  venereal 
diseases  will  be : 

(a)  Securing  reports  of  venereal  infections  from  physicians  and  others  re- 
quired to  report  in  accordance  with  State  laws. 

(&)  Suppressive  measures,  including  the  isolation  and  treatment  in  detention 
hospitals  of  infected  persons  who  are  unable  or  unwilling  to  take  measures  to 
prevent  themselves  becoming  a,  menace  to  others,  the  establishment  of  free 
clinics  for  the  treatment  of  venereal  diseases,  and  the  elimination  of  conditions 
favorable  to  the  spread  of  venereal  infections. 

(c)  Extension  of  facilities  for  early  diagnosis  and  treatment  through  labora- 
tory facilities  for  exact  diagnosis  and  scientific  determination  of  condition 
before  release  as  noninfectious,  in  accordance  with  the  standardized  procedure 
that  will  be  prescribed  by  the  United  States  Public  Health  Service. 

(d)  Educational  measures  to  include  informing  the  general  public,  as  well  as 
infected  individuals,  in  regard  to  the  nature  and  manner  of  spread  of  venereal 
diseases  and  the  measures  that  should  be  taken  to  combat  them. 

(e)  Cooperation  with  local  civil  authorties  in  their  efforts  to  suppress  public 
and  clandestine  prostitution.  The  clinics  referred  to  under  (&)  will  form 
centers  from  which  the  other  measures  may  be  conducted  by  discovering  the 
presence  of  infections,  the  securing  of  data  for  enforcing  the  regulations  for 
reporting  these  diseases,  and  the  institution  of  educational  measures  appro- 
priate to  particular  communities.  The  immediate  reduction  in  venereal-disease 
foci  resulting  from  clinic  treatment  will  result  in  a  marked  decrease  in  the 
prevalence  of  such  diseases  in  both  the  military  and  civil  population. 

(/)  Accurate  detailed  records  must  be  kept  of  all  the  activities  of  the 
venereal-disease  work.  These  will  include  careful  records  of  each  case  treated, 
amount  of  arsphenamine  used,  final  results,  and  disposition  made  of  patients. 
Copies  of  these  records  must  be  forwarded  to  the  Surgeon  General,  United 
States  Public  Health  Service,  as  a  report  at  such  intervals  as  they  may  be 
requested,  and  in  accordance  with  instructions  regarding  the  form  of  report. 

3.  Local  funds  that  may  be  available,  or  that  may  become  available  from 
legislative  appi'opriations  or  any  other  source  for  veneral-disease  control,  shall 
be  used  by  the  State  or  city  health  authorities  having  jurisdiction  for  the  ex- 
tension of  the  work,  and  such  local  funds  must  not  be  conserved  through  the 
expenditure  of  the  funds  that  are  allotted  by  the  Congress  through  the  United 
States  Interdepartmental  Soci.al  Hygiene  Board. 

4.  In  extension  of  the  educational  measures  the  State's  health  authorities  and 
its  bureau  of  venereal  diseases  shall  exert  their  efforts  and  influence  for  the 
organization  of  a  State  venereal-disease  committee  that  will  be  unofficial  in 
character  but  a  valuable  cooperative  agency  for  furthering  the  comprehensive 
plan  for  nation-wide  venereal-disease  control. 

5.  The  State  health  authorities  shall  take  such  measures  as  may  be  found 
practicable  and  decided  upon  in  conference  between  the  Public  Health  Service 
and  State  board  of  health  representatives  for  the  purpose  of  securing  such  addi- 
tional legislation  as  may  be  required  for  the  development  of  control  of  the 
spread  of  venereal  infections.  Action  shall  be  taken  to  limit  or  suppress  the 
activities  of  advertising  "  specialists  "  and  quacks  by  prosecuting  them  under 
State  laws  or  such  other  measures  as  may  be  applicable  and  effective. 

6.  In  expending  the  sum  allotted  a  State,  the  rules  and  regulations  to  be 
promulgated  by  the  United  States  Interdepartmental  Social  Hygiene  Board  for 
the  expenditure  of  the  $1  000,000  civilian  quarantine  and  isolation  fund  under 
control  of  the  Secretary  of  War  and  Secretary  of  the  Navy  shall  be  given  con- 
sideration by  Public  Health  Service  and  State  board  of  health  representatives, 
so  that  the  military  necessities  of  each  particular  State  may  receive  the  con- 


•       KEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     217 

sideration  due  its  relative  importance  and  so  that  funds  from  the  two  sources 
may  be  correlated. 

7.  The  State  allotment  shall  be  expended  along  general  standard  lines  for  all 
States  and  in  accordance  with  an  accounting  system,  to  be  forwarded  by  the 
United  States  Interdepartmental  Social  Hygiene  Board,  approximately  as 
follows : 

(a)   For  treatment  of  infected  persons  in  hospitals,  clinics,  and  other  institu- 
tions, including  arsphenamine  and  other  drugs,  50  per  cent  of  the  allotment. 
(6)   In  carrying  out  educational  measures,  20  per  cent. 

(c)  In  carrying  out  repressive  measures,  20  per  cent. 

(d)  In  general  administ'ration  and  other  activities  of  venereal-disease  con- 
trol work,  10  per  cent. 

(This  distribution  is  provisional  and  subject  to  modification  after  conference 
and  agreement  between  each  State  and  the  United  States  Public  Health  Service 
to  best  meet  the  needs  of  the  particular  State.) 

8.  In  carrying  out  the  general  Government  program  the  administrative 
organization  of  the  United  States  Public  Health  Service  will  be  available  at  all 
times  to  State  organizations  in  cooperative  work,  and  assistance  will  be  given 
to  States  whenever  possible  through  the  detail  of  employees,  the  securing  of 
arsphenamine,  providing  literature  for  the  educational  measui'es,  and  in  such 
other  ways  as  may  be  found  practicable  as  the  work  develops. 

W.  G.  McAdoo, 
Secretary  of  the  Treasury. 
Washington,  D.  C,  September  4,  1918. 

4.  Appropriation  for  fiscal  year  1921. — For  the  fiscal  year  ending  June  30, 
1921,  Congress  provided  in  the  sundry  civil  bill  the  following  appropriation  for 
the  cooperative  work  with  the  States : 

The  duties  and  powers  conferred  upon  the  United  States  Interdepartmental 
Social  Hygiene  Board  by  chapter  15  of  the  Army  appropriation  act  approved 
July  9,  1918,  with  respect  to  the  expenditure  of  the  appropriations  made  therein 
are  extended  and  made  applicable  to  the  appropriations  for  similar  purposes 
made  in  this  act. 

******* 

For  allotment  to  the  various  States  for  prevention,  treatment,  and  control  of 
venereal  diseases,  $450,000;  and  the  unexpended  balance  on  June  30,  1920  (ap- 
proximately $300,000),  of  the  appropriation  heretofore  made  for  this  purpose 
is  continued  and  made  available  during  the  fiscal  year  1921 :  Provided,  That  no 
part  of  this  sum  shall  be  allotted  to  any:  State  unless  such  State,  in  a  manner 
satisfactory  to  the  board,  shall  have  complied  with,  and  shall  have  given  assur- 
ance of  continued  compliance  with,  the  condition  and  regulations  governing  such 
allotments  and  the  expenditures  that  may  be  made  therefrom. 

5.  Reduction  in  appropriation  for  1921. — It  will  be  noted  from  the  above  act  of 
Congress  that  the  Federal  Government's  appropriation  for  allotment  to  the 
States  was  reduce<l  from  $1,000,000  for  1919  and  $1,087,831.41  for  1920  to 
$450,0<:)0  plus  the  unallotted  balance  of  June  30,  1920. 

6.  Allotmeni  to  States  for  1921. — At  the  present  writing  /the  exact  amount 
which  will  be  available  for  allotment  to  States  for  the  prevention,  control,  and 
ti'eatment  of  venereal  diseases  is  not  definitely  known,  and  will  not  be  until  after 
July  1,  for  the  reason  that  Congress  appropriated  the  unexpended  balance  (the 
balance  for  which  the  States  did  not  qualify  by  specifically  appropriating  or 
otherwise  setting  aside  an  equal  amount).  At  the  time  this  appropriation  was 
being  considered  by  Congress  it  was  estimated  this  unexi)ended  balance  would 
be  approximately  $350,000,  but  since  some  States  have  qualified  subsequently. 


218      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

this  estimated  balance  will  be  very  materially  decreased.  States  will  be  ad- 
vised regarding  the  exact  total  and  the  allotment  to  each  as  soon  as  it  is  defi- 
nitely determined. 

ALLOTMENTS PEKCENTAGE — POPULATION. 

7.  Basis  of  allotments  to  States. — In  accordance  with  the  act  of  Congress 
directing  that  payments  to  be  made  to  the  States  be  allotted  to  each  State  in 
proportion  which  its  population  bears  to  the  population  of  the  continental  United 
States  according  to  the  last  preceding  United  States  census,  the  allotments  for 
1919-20  and  1921  are  based  on  the  following  table : 

Population  of  continental  United  States,  census  of  1910. 


state. 


Population. 


Alabama 

Ari  -ona 

Arkansas 

Caliiornia 

Colorauo 

CoiQBJticut 

Dela  A'are 

District  of  Commbia 

Floriaa 

Georgia 

Idaho 

Illinois 

Indiana 

lo.va 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massichusetts 

Mic  igan 

Minnesota 

Mi3>i3iippi 

Missouri 

Montana 

Nebraska 


138,093 
204,354 
5, "4, 449 
377,  M9 
7W,024 
114,758 
2.J2,322 
331,069 
752,619 
609, 121 
325, 594 
638, 591 
700, 876 
224,771 
690, 949 
289, 905 
656,388 
742,371 
2J5,346 
366,416 
810,175 
075, 708 
797,114 
293,335 
376, 053 
192,214 


Percentage. 


2.324715 

.222191 

1.711874 

2  OS5372 

.  868766 

1.212057 

.219981 

.3.59966 

.818311 

2- 836856 

.354013 

6  130751 

2.936620- 

2.418958 

1.838542 

2  489777 
1.800965 

. 807168 
1.408409 

3  660251 
3  055157 
2.253885 
1. 953974 
3.580791 

.408876 
1.296275 


State. 


Population. 


Nevada 

New  Hamp.shire 

New  Jersey 

New  Me.iico 

Ne.v  York 

North  Carolina. . 
North  Dakota... 

Ohio 

Oklahoma 

Oregon 

Pennsyhania. .. 
Rho.ie Island.. . 
South  Carolina.. 
South  Dakota. . . 

Tennessee 

Texas 

Utah 

Vermont 

Virginia :... 

Vv'ashington 

West  Virginia... 

Wisconsin 

W^yoming 

Total 


81,875 
430, 572 
537,167 
327,301 
113,614 
206, 287 
557, 0.56 
767, 121 
657, 155 
672, 765 
665,111 
M2,bia 
515,400 
583, 888 
184,789 
896, 542 
373,351 
355, 956 
061,612 
141,990 
221,119 
333, 860 
145,965 


Percentage. 


0.089021 

.468154 
2.758622 

. 355870 
9. 909089 
2.398861 

. 627424 
5  183216 
1.801799 

. 731487 
8.334155 
.  ..589972 
1.047671 

.  634.852 
2.375487 
4.236649 

.405939 

.387026 
2  241558 
1.241668 
1  327704 
2. 537570 

.  158705 


100 


UNEXPENDED  BALANCES,   1919-20. 

8.  Comptroller's  decision. — Under  date  of  May  18,  1920,  the  board  addressed 
a  letter  to  the  Comptroller  of  the  Treasury,  in  part,  as  follows : 

If  a  State,  in  accordance  with  the  above-quoted  section  of  the  act,  did  "  speciti- 
cally  appropriate  or  otherwise  set  aside  "  an  amount  equal  to  the  Federal  allot- 
ment for  the  fiscal  year  ending  June  30,  1920,  and  by  so  doing  complied  with  the 
act,  does  this  action  of  the  State  create  a  liability  against  the  appropriation  made 
by  Congress  which  may  be  paid  by  the  board  after  June  30,  1920?  If  the  action 
of  the  State  in  specifically  appropriating  or  otherwise  setting  aside  an  equal 
amount  may  be  con.sidered  as  creating  a  liability  against  the  appropriation,  the 
board  would  like  to  continue  making  monthly  disbursements  of  50  per  cent  of 
the  paid  vouchers  submitted,  rather  than  to  pay  over  to  the  States  before  June 
80,  in  a  lump  sum,  the  balance  due  them,  and,  therefore,  it  is  respectfully  re- 
quested that  you  advi.se  me  if  the  board  is  authorized  to  use  its  .judgment  as  to 
the  advisiability  of  making  monthly  payments,  or  paying  in  full,  after  the  ex- 
piration of  the  fiscal  year,  any  balance  due  a  State  on  its  allotment  for  the  fiscal 
year  ending  June  30,  1920. 

In  reply  to  that  letter  the  comptroller  advised  as  fallows : 

The  authority  to  make  allotments  to  the  State  given  by  the  act  of  June  30. 
1919  (40  Stat.,  8§6),  is  in  accordance  with  rules  and  regulations  prescrilKMl  by 


REPORT  U.  S.  INTERDEPARTMENTAIi  SOCIAL  HYGIENE  BOARD.     219 

the  Secretary  of  the  Treasury.  The  allotment  itself  is  in  such  cases  the  actual 
Incurrence  of  liability  against  the  appropriation,  and  that  having  been  made 
within  the  fiscal  year  the  subsequent  data  required  do  not  affect  the  use  of  the 
appropriation. 

board's  regulations  regarding  payment  of  balances. 

9v  In  accordance  with  this  ruling  the  board  has  adopted  the  following  rules 
regarding  payments  of  the  balance  due  the  State  for  the  fiscal  years  1920  and 
1921: 

(a)  In  the  discretion  of  the  board  no  further  payments  will  be  made  to  a 
given  State  from  its  allotment  that  became  available  for  the  Federal  fiscal  year 
1920  until  that  State  has  spent  and  satisfactorily  accounted  for  the  allotment 
paid  over  to  it  for  the  Federal  fiscal  year  1919. 

(6)  When  a  given  State  shall  have  expended  and  satisfactorily  accounted 
for  the  entire  allotment  paid  over  to  it  by  the  board  for  the  Federal  fiscal  year 
1919  the  board,  in  its  discretion,  will  pay  over  to  the  treasurer  of  that  State, 
la  a  lump  sum,  the  entire  balance  of  the  allotment  due  that  State  for  the  Fed- 
eral fiscal  year  1920, 

(c)  In  the  discretion  of  the  board  no  payment  will  be  made  to  a  given  State 
from  its  allotment  for  the  Federal  fiscal  year  1921  until  that  State  has  expended 
and  satisfactorily  accounted  for  the  joint  balance  on  hand ;  that  is,  for  its  allot- 
ment from  the  Govei-nment  and  also  for  its  own  balancing  appropriation  cover- 
ing the  allotment  from  the  Government  for  the  Federal  fiscal  year  1920. 

(d)  States  will,  however,  commencing  July  1,  1920,  begin  making  disburse- 
ments from  their  State  appropriations,  for  the  fiscal  year  1921,  accounting  for 
the  same  on  a  pink-colored  voucher  form  to  be  provided  by  the  board  for  that 
purpose.  They  will  do  this  regardless  of  whether  or  not  the  board  is  withholding 
payments  for  any  prior  fiscal  year.  These  vouchers,  which  are  to  be  paid  en- 
tirely from  the  State  appropriations  for  the  fiscal  year  1921,  will  be  submitted  to 
-the.  b.oard  monthly  and  summarized  on  the  pink-colored  monthly  report  to  be 
provided  by  the  board  for  that  purpose.  The  board  will  audit  these  vouchers 
as' received,  but  withhold  making  50  per  cent  payment  until  the  previous  allot- 
CQenf  or  allotments  for  prior  fiscal  years  are  accounted  for  and  approved  by  the 
board. 

STATE  CERTIFICATES. 

10.  Certifying  to  State  appropriations. — Before  any  State  may  receive  any 
portion  of  its  allotment  for  which  it  has  qualified  by  specifically  appropriating 
or  otherwise  setting  aside  a  specified  sum  of  money,  it  will  be  necessary  for  the 
State  treasurer  to  deliver  to  the  United  States  Interdepartmental  Social  Hygiene 
Board,  properly  signed  and  executed  State  certificates  in  duplicate,  certifying 
that  the  State  has  complied  with  the  act  of  Congress  "  by  specifically  appropri- 
ating or  otherwise  setting  aside  "  a  stated  amount  "  for  the  use  of  its  depart- 
ment or  board  of  health  in  the  prevention,  control,  and  treatment  of  venereal 
diseases."  One  copy  of  this  certificate  will  be  filed  by  the  United  States  Inter- 
departmental Social  Hygiene  Board  with  the  accounting  officers  of  the  United 
States  Treasury  Department  in  Washington,  D.  C,  and  one  copy  will  be  re- 
tained in  the  files  of  the  board. 

These  certificates  must  be  accompanied  by  one  printed  or  properly  certified 
copy  of  the  State  legislative  bill  providing  the  appropriation  to  which  the  State 
treasurer  is  certifying.  This  copy  of  the  State  legislative  bill  will  be  retained  in 
the  files  of  the  board. 


220      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD» 

JOINT    STATE   AND   FEDEHAL   BUDGETS. 

11.  F'ortvardlng  budgets. — Before  any  State  may  receive  any  portion  of  the 
Federal  allotment  for  which  it  qualifies  it  will  be  necessary  to  deliver  to  the 
United  States  Interdepartmental  Social  Hygiene  Board  a  properly  made  out  and 
signed  joint  State  and  Federal  budget  in  triplicate,  equaling  the  total  of  both 
the  State  appropriation  and  the  F'ederal  allotment.  Should  the  State  appropria- 
tion exceed  the  Federal  allotment  "the  budget  will  be  made  for  only  double  the 
"amount  of  the  latter,  and  should  the  State  appropriation  be  for  a  lesser  amount 
than  the  Federal  allotment  the  budget  will  be  made  for  only  double  the  State 
appropriation.  In  preparing  the  joint  State  and  Federal  budget  no  division 
should  be  made  between  Stqte  and  Federal  funds. 

12.  Where  State  appropriations  exceed  Federal  allotment. — States  are  advised 
that  where  their  appropriation  for  prevention,  control,  and  treatment  of  venereal 
diseases  exceeds  the  Federal  allotment  the  board  does  not  require  information 
of  any  sort  whatsoever  concerning  the  excess  State  appropriation.  The  ex- 
penditures therefrom  are  not  to  be  reported  to  the  board. 

13.  Budget  account  numbers. — In  view  of  past  experience  in  disbursing  these 
joint  funds,  State  officers  should  now  be  able  to  prepare  their  joint  budgets  in 
more  complete  detail  and  allot  the  funds  with  more  accuracy  so  that  the  budget 
may  meet  every  contingency  and  prevent  overdrawing  on  any  specified  budget 
account.  It  is  requested  that  especial  care  be  given  to  this  subject,  as  the 
method  of  accounting  by  budget  account  number  makes  it  essential  that  an 
individual  account  be  kept  with  each  activity  or  project,  in  addition  to  the  four 
general  accounts.  If  the  joint  budget  is  not  carefully  drawn  it  .will  require 
numerous  transfers  and  revisions  which  will  complicate  the  accounting. 

14.  Where  legislatures  itemize  State  appropriations. — If  a  State  legislative 
body  instead  of  appropriating  in  a  lump  sum  has  made  an  appropriation  in 
more  detail  by  itemizing  certain  specific  objects  and  the  amounts  available  for 
each,  it  will  be  necessary  when  making  the  budget  to  state  thereon  the  exact 
objects  and  amounts  as  outlined  in  the  State  appropriation.  However,  this 
fact  need  not  interfere  with  a  distribution  of  such  amounts  under  the  four 
general  classifications  of  expenditures,  but  in  no  case  should  any  such  specific 
amount  be  divided.  It  should  be  classified  as  a  total,  ignoring  percentages 
given.  These  entries  on  the  budget  will  be  followed  by  the  proposed  expenditures 
of  the  Federal  allotment,  and  this  portion  of  the  budget  should  be  given  in  as 
much  detail  as  possible  and  in  compliance,  with  tho  percentages  given  to  each 
classification. 

15.  Where  States  appropriate  in  a  lump  sum. — Of  course,  where  a  State  appro- 
priation is  not  itemized  but  made  in  a  lump  sum,  it  is  expected  that  State 
officials  will  give  as  much  detail  to  the  budgeting  of  the  State  appropriation  as 
to  the  Federal  allotment  and  also  attempt  to  comply  as  far  as  the  particular 
needs  of  their  State  Avill  allow  with  the  percentages  given  to  each  classification 
as  specified  in  the  regulations  promulgated  by  the  Secretary  of  the  Treasury. 

However,  attention  is  directed  to  the  fact  that  those  percentages  are  provi- 
sional and  subject  to  modifications  to  meet  the  particular  needs  of  each  State. 

SAMPLE   JOINT    STATE   AND   FEDERAL   BUDGET. 

16.  The  Boai-d  has  prepared  a  "  Sample  joint  State  and  Federal  budget " 
filled  out  for  the  guidance  of  State  departments  or  boards  of  health.  This 
sample  budget  may  be  useful  in  suggesting  the  State  form  but  is  not  submitted 
to  be  copied,  as  each  State  has  its  particular  problems  to  meet  and  a  uniform 
budget  is  not  practicable  or  desirable. 


REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD.     221 

Tip:VI,S)01)  Jf)INT   S'lA'IK   AND   FKDKHAT,  HUDGET. 

17.  The  board  has  prepared  a  blank  "  Revised  joint  State  and  Federal  budget  " 
(Form  No.  20)  for  the  use  of  State  departments  or  boards  of  health.  This 
form  is  to  be  used  in  formulating  budgets  covering  tlie  balance  of  the  joint 
State  and  Federal  account  remaining  on  hand  at  the  close  of  a  liscal  year  (.Tune 
30).  This  revised  budget  should  be  made  out  promptly  after  closing  the  State 
books  for  the  month  of  June  and  forwarding  the  account  for  that  month  to  the 
board.  It  should  be  made  to  cover  the  exact  amount  of  the  joint  balance  un- 
accounted for  at  that  time.  This  revised  budget  should  be  made  out  to  meet 
the  needs  of  the  State  venereal-disease  program  without  reference  to  the 
previous  budget.  In  making  this  revision  consideration  should  be  given  by  State 
officials  to  the  joint  State  and  Federal  budget  to  be  submitted  for  the  succeeding 
fi.«ical  year  beginning  .July  1. 

THE    50-50    PLAN. 

18.  For  the  year  1919. — The  allotments  for  the  fiscal  year  1919  were  not  con- 
ditioned upon  the  States  contributing  or  appropriating  any  sum,  but  for  the  fiscal 
years  ending  June  30,  1920  and  1921,  they  were  conditioned  upon  each  State  "spe-* 
cifically  appropriating  or  otherwise  setting  aside  "  an  equal  amount  to  meet  the 
Federal  Government's  allotment. 

Inasmuch  as  thes^Federal  allotments  for  the  fiscal  year  1919  were  not  condi- 
tioned upon  the  State's  appropriating,  and  in  order  to  expedite  the  commencing 
of  the  work,  it  was  thought  advisable  at  that  time  to  pay  each  State's  allot- 
ment in  full  in  a  lump  sum  to  be  expended  subject  to  a  State  budget  to  be  sub- 
mitted, and  in  accordance  with  certain  regulations  furnished  by  the  board. 

19.  For  the  years  1920  and  1921. — However,  for  the  fiscal  years  1920  and  1921 
a  different  procedure  became  necessary  for  the  reasons  that  the  law  as  enacted 
by  Congress  and  the  regulations  of  the  Secretary  of  the  Treasury  made  it  com- 
pulsory that  the  United  States  Interdepartmental  Social  Hygiene  Board  see  that 
each  dollar  paid  by  it  for  the  purposes  stated  in  the  act  was  matched  by  a  dollar 
paid  by  the  States. 

20.  The  50-50  plan. — Section  3  of  the  regulations  of  the  Secretary  of  the 
Treasury  reads : 

Funds  that  may  become  available  from  legislative  appropriations  must  not  be  con- 
served through  the  expenditure  of  funds  allotted  by  Congress. 

The  board  has  interpreted  the  above  section  to  mean  that  a  State  must  not 
spend  the  Federal  allotment  before  spending  the  appropriations  made  by  the 
State,  but  that  it  must  be  a  "  50-50  "  plan. 

21.  Practice  of  other  Government  departments. — It  is  the  general  practice  of 
Government  departments  and  independent  establishments  charged  with  expend- 
ing Federal  appropriations  made  for  State  and  other  activities  conditioned  upon 
the  matching  of  dollar  for  dollar,  to  require  the  State  to  first  make  the  disburse- 
ments from  their  appropriation,  submitting  the  paid  vouchers  for  audit.  The 
Government  department  then  pays  to  the  State  50  per  cent  of  such  expenditures 
as  may  be  found  to  be  correct.  This  procedure  serves  the  double  purpose  of  as- 
certaining if  the  disbursements  as  made  are  in  accordance  with  the  regvdations 
governing  the  disbursements,  and  also  that  the  State  has  complied  with  the 
Federal  law  by  not  only  appropriating  an  equal  amount,  but  by  actually  expend- 
ing its  proportion. 

22.  50-50  plan  adopted  hy  hoard. — The  United  States  Interdepartmental  Social 
Hygiene  Board  has  adopted  this  procedure  for  disbursing  tlie  allotments  to  States 
for  the  fiscal  year.s*  1920  and  1921,  and  it  is  therefore  necessary  that  the  State 


222      REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD. 

official  making  disbursements  from  these  funds  forward  to  tliis  office  at  the 
close  of  each  month,  on  forms  provided  by  the  board,  a  statement  of  such  ex- 
penditures accompanied  by  the  paid  vouchers.  A  Treasury  warrant  covering 
50  per  cent  of  such  disbursements,  the  proportion  payable  by  the  Federal  Gov- 
ernment, will  then  be  promptly  paid  to  the  State  treasurer. 

Paid  vouchers  submitted  by  a  State  and  found  not  to  fully  comply  with  the 
regulations  of  the  board  governing  expenditures  from  this  fund  will  be  either 
disallowed  and  returned  or  suspended,  pending  the  receipt  of  further  informa- 
tion, and  50  per  cent  of  the  remaining  amount  will  be  paid. 

PAYMENT. 

23.  Disposition  of  monthly  payments. — State  treasurers  are  advised  that  these 
payments  made  by  the  United  States  Interdepartmental  Social  Hygiene  Board 
are  not  to  be  considered  repayments  to,  or  reimbursement  of,  any  State  appro- 
priation. They  are  to  be  considered  as  merely  monthly  or  periodical  payments 
by  the  Federal  Government  of  allotments  made  for  a  specific  purpose,  and,  there- 
fore, can  not  in  any  way  be  considered  as  State  revenues,  and  must  not  be  so 
credited.  It  was  not  the  intention  of  Congress  to  appropriate  funds  for  co- 
operative work  with  the  States  which  would  require  a  State  legislation  act  to 
make  them  available.  The  United  States  Interdepartmental  Social  Hygiene 
Board  will  not  deposit  any  portion  of  a  State's  allotment  in  any  State  where  Its 
officials  so  construe  its  laws. 

These  monthly  or  periodical  payments  should  be  considered  by  State  treas- 
urers as  trust  funds  for  the  use  of  the  State  department  or  board  of  health  in 
the  prevention,  control,  and  treatment  of  venereal  diseases,  and  he  should  so 
credit  them. 

24.  Suspended  vouchers. — ^Any  voucher  or  vouchers  suspended  by  the  board 
pending  further  information  may  be  resubmitted  with  the  following  month's 
account. 

Suspended  vouchers  resubmitted  for  50  per  cent  reimbursement  should  be 
listed  as  the  last  entries  on  the  monthly  report  in  memorandum  form ;  that  is, 
they  should  be  given  the  original  voucher  numbers,  but  not  added  in  with  the  ex- 
penditures for  the  current  month,  inasmuch  as  they  were  previously  deducted 
from  the  available  balances  on  the  back  of  the  monthly  report  when  originally 
submitted. 

25.  Disposition  of  paid  vouchers. — The  United  States  Interdepartmental  Social 
Hygiene  Board  having  been  charged  with  the  duty  of  paying  the  Federal  allot- 
ment, making  rules  and  regulations  for  its  expenditure  and  the  supervision  of 
the  disbursements,  it  will  be  necessary  to  have  on  file  in  the  office  of  the  board 
In  Washington,  D.  C,  evidence  of  the  proper  disbursement  of  these  funds,  and 
such  monthly  reports  and  paid  vouchers  as  may  be  submitted  by  the  States 
will  be  retained  and  become  the  property  of  the  board. 

UNIFORM   ACCOUNTING. 

26.  In  order  that  all  States  may  have  a  uniform  system  of  accounting,  the 
board  has  prepared  special  voucher  forms  and  monthly  report  forms  to  be  used 
by  all  States  in  transmitting  their  accounts  to  Washington  for  settlement. 

VOUCHER  FOEM. 

27.  All  disbursements  made  from  these  funds  (both  State  and  Federal), 
Including  salary  payments  and  reimbursements  for  travel,  are  to  be  submitted 
on  the  special  form  of  the  board. 


REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     223 

28.  Year  1919. — In  disbursing  the  remainder  of  the  allotment  for  the  fiscal 
year  1919  the  white  voucher,  Form  No.  8,  and  white  monthly  report,  Form  No. 
9,  will  be  used. 

29.  Years  1920  and  1921.— lu  disbursing  the  balance  of  the  1920  joint  State 
and  Federal  fund,  the  blue  voucher,  Form  No.  8-A,  and  the  blue  monthly  report, 
Form  No.  9-A,  will  be  used;  and  in  disbursing  the  joint  State  and  Federal 
fund  for  the  fiscal  year  1921  the  pink  voucher,  Form  No.  8-B,  and  the  pink 
monthly  report.  Form  No.  9-B,  will  be  used, 

30.  Use  of  right  form. — Special  attention  is  directed  to  the  use  of  the  right 
form  when  forwarding  disbursements  to  the  board.  Vouchers  submitted  on  the 
wrong  forms  will  be  returned. 

31.  Number  of  vouchers  to  he  made. — These  vouchers  may  be  made  in  dupli- 
cate, tiiplicate,  or  quadruplicate,  in  accordance  with  the  special  requirements 
of  each  State.  One  copy  shall  be  forwarded  to  the  United  States  Interdepart- 
mental Social  Hygiene  Board  in  Washington,  D.  C,  and  one  or  more  copies 
may  be  retained  by  the  State. 

32.  Signatures. — The  State  ofRc-ers  must  assume  all  responsibility  for  liabili- 
ties incurred  in  connection  with  the  expenditures  of  these  funds,  must  prepare 
the  voucher  forms  approving  the  same  as  correct,  obtain  the  signature  of  the 
payee  and  the  certificate  of  the  paying  official.  The  paying  official  must  in  all 
eases  obtain  the  personal  signature  of  the  payee  and  certify  to  the  payment. 
Vouchers  signed  for  the  payee  per  some  one  else  can  not  be  accepted,  unless 
a  satisfactory  explanation  accompanies  the  voucher,  but  salary  and  travel- 
ing-expense vouchers  under  no  circumstances  will  be  accepted  unless  they 
bear  the  payee's  personal  signature.  Rubber-stamp  signature  of  the  approving 
ofiicial  or  the  paying  ofiicial  is  not  acceptable  unless  initialed  by  the  person 
designated  to  use  the  same,  and  in  such  cases  a  letter  must  be  forwarded  to 
the  board  advising  the  name  of  the  person  authorized  to  initial  and  submitting 
a  specimen  of  the  rubber-stamp  signature  and  initials  of  person  designated  as 
they  will  appear  on  the  vouchers. 

33.  Company  or  corporation. — Where  a  voucher  is  certified  in  the  name  of 
a  company  or  corporation,  the  name  of  the  person  writing  the  company  or 
corporate  name,  as  well  as  the  capacity  in  which  he  signs,  must  appear.  Ex- 
ample :  "  Chicago  Edison  Co.,  per  John  Smith,  member  of  firm,"  or  "  secretary  " 
or  "  treasurer,"  as  the  case  may  be.  A  complete  signature  with  a  rubber  stamp 
is  not  acceptable. 

34.  More  than  one  item. — One  voucher  may  contain  any  number  of  items, 
but  must  be  made  out  in  the  name  of  but  one  individual,  firm,  or  corporation. 
Where  there  are  a  number  of  items  appearing  on  the  bill,  the  invoice  of  the 
payee  may  be  attached  to  the  vouclier  and  a  statement  made  on  the  face  of  the 
voucher  "  as  per  invoice  hereto  attached,"  extending  the  total  and  classifying 
as  if  one  item,  but  in  all  such  cases  the  itemized  invoice  must  be  attached  to  the 
voucher  transmitted  to  this  office. 

35.  Reimbursement  for  cash  purchases. — An  official  making  numerous  small 
purchases  and  paying  cash  at  the  time  from  his  personal  funds  and  obtain- 
ing receipted  bills  for  such  purchases  may,  by  attaching  such  miscellaneous 
receipts  to  a  voucher  drawn  payable  to  himself,  obtain  reimbursement  for  such 
expenditures.  In  all  such  cases  he  will  be  required  to  list  on  the  voucher  the 
vendors'  names  and  the  amounts  paid  each.  The  voucher  forwarded  to  this 
office  must  also  have  the  receipted  bills  attached.  This  procedure  is  authorized 
only  in  cases  of  emergency  or  where  the  purchase  amounts  to  less  than  $1  and 
Is  not  to  be  interpreted  as  authorizing  the  use  of  subvouchers  covering 
small  monthly  or  periodical  payments,  such  as  telephone,  ice,  rent,  etc.,  to 
avoid  forwarding  individual  vouchers,  and  in  no  case  must  such  a  reimburse- 
ment voucher  contain  a  payment  for  personal  service. 


224     REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

36.  Travel  ea-'penses.— Reimbursement  of  travel  expenses  must  be  handled  as 
follows :  In  no  case  will  travel  expenses  be  allowed  which  are  not  confined  to 
the  usual  expenses  incurred  for  the  ordinary  comforts  of  a  traveler.  Receipts 
should  be  obtained  for  transportation  and  hotel  bills,  when  possible  to  do  so, 
but  it  will  be  unnecessary  to  obtain  receipts  for  meals  and  the  various  small 
incidental  expenses  of  travel  unless  required  by  the  State. 

When  supplies  are  purchased  while  in  a  travel  status,  receipted  invoices  of 
the  dealer  must  be  attached  to  the  travel  voucher  to  substantiate  the  claim. 

If  certified  statements  of  travel  expenses  made  on  a  State  form  are  available, 
it  is  requested  that  the  same  be  attached  to  the  voucher  transmitted  to  this 
office.  If,  however,  State  officials  require  these  statements  and  invoices,  copies 
should  be  made  for  transmittal  with  the  voucher.  In  the  absence  of  such  a 
statement  or  copy,  the  travel  expense  should  be  itemized  as  completely  as  pos- 
sible on  the  face  of  the  voucher,  as  the  mere  statement  "  Traveling  expenses  " 
is  not  considered  sufficient. 

If  it  should  be  necessary  to  use  taxicabs  or  automobiles  while  in  a  travel 
status,  the  voucher  should  contain  the  following  notation :  "  No  other  means 
of  transportation  available." 

Where  a  State  authorizes  automobile  mileage  and  the  same  is  paid  from  the 
State  appropriation  and  submitted  on  the  special  State  form'  covering  such 
expenditure  it  will  be  allowed  by  the  board. 

Travel  outside  of  the  State  will  not  be  approved  unless  authorized  by  the 
board. 

Books  containing  blank  receipts  conveniently  printed  and  small  daily  expense 
account  books  for  travelers  will  be  supplied  by  the  board  upon  request. 

37.  Salaries. — In  making  vouchers  covering  payment  of  salary  for  services 
rendered  the  date  "  from  "  and  "  to  "  which  payment  is  being  made  (both  these 
dates  inclusive)  must  be  shown  on  voucher  as  well  as  the  designation  of  posi- 
tion (i.  e.,  stenographer,  V.  D.  oflScer,  etc.)  and  the  monthly  or  annual  rate  of 
compensation. 

38.  No  employee  of  the  United  States  Interdepartmental  Social  Hygiene 
Board  shall  receive  any  salary,  travel  expense,  allowance,  or  compensation  of 
any  nature  whatsoever  from  any  State  for  services  rendered  in  connection 
with  their  official  duties. 


39.  Preparation  of  voucher. — In  pi'eparing  voucher  to  cover  reimbursement 
to  clinics,  detention  houses,  and  like  institutions  for  salaries,  treatment,  main- 
tenance, supplies,  or  equipment  the  voucher  must  be  accompanied  by  an  itemzied 
statement  giving  details  of  the  expenditures  incui-red. 

40.  Advance  payments. — In  no  case  shall  any  amounts  be  advanced  to  these 
institutions  or  clinics  before  the  liabilities  are  actually  incurred  by  them-. 

41.  Subsidies  to  clinics. — Payments  in  advance  of  the  actual  performance  of 
the  service  or  the  delivery  of  the  supplies  is  strictly  forbidden  by  Federal  law 
and  will  not  be  allowed  under  any  circumstance.  Therefore  advance  payments 
to  clinics  under  the  name  of  "  subsidies  "  is  prohibited  by  the  board,  and  no 
such  payments  shall  be  made  in  advance  of  the  expiration  of  the  period  covered 
by  the  designated  "  subsidy."  However,  there  is  no  objection  to  making  such 
payments  on  a  monthly  basis,  provided  the  payments  are  not  made  until  the 
expiration  of  the  month  designated  in  the  voucher. 

OBTAINING    SIGNATUEES    TO    VOUCHEES. 

42.  In  advance  of  payment. — In  order  to  secure  signatures  to  vouchers 
promptly  and  thus  avoid  any  delay  in  obtaining  reimbursement  it  is  suggested 
that  the  vouchers  be  completely  prepared,  with  the  exception  of  the  approvals 


KEPOET  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      225 

and  voucher  number,  and  forwarded  to  the  payee  with  a  foi'in  lettoi-  requestinfc 
that  the  voucher  be  properly  signed  and  returned,  stating  that  check  will  be 
forwarded  promptly  upon  the  return  of  the  same.  This  is  the  procedure  fol- 
lowed by  all  the  Government  departments  and  is  recomm'ended  in  the  disljurse- 
inent  of  this  fund  by  the  States.  There  can  be  no  reasona))le  objection  raised 
by  the  payee,  for  the  reason  that  the  States  are  responsible  and  reliable,  and 
the  form  letter  requesting  the  signature  in  advance  of  the  payment  is  ample 
protection  to  the  payee  in  case  the  payment  should  not  be  made  as  promised. 

43.  After  the  payment  is  made. — In  States  where  the  procedure  is  to  forward 
the  vouchers  for  signature  with  the  State  warrant  or  after  the  payment  has 
been  made  the  voucher  so  forwarded  should  not  be  given  a  number  until  it. 
is  returned.  This  will  avoid  the  necessity  for  holding  vouchers  otherwise 
ready  to  submit  pending  the  receipt  of  one  or  two  vouchers  forwarded  for' 
signature  and  not  returned  in  time  to  be  included  in  the  disbursements  for  the 
month.  Tliese  delayed  vouchers  may  then  be  given  a  number  whenever  received 
and  transmitted  to  the  board  with  the  next  regular  report. 

BOOKS,    PEKIODICALS,    AND    AUTOMOBILES. 

44.  ProMMted. — Particular  attention  is  called  to  the  fact  that  the  use  of  this' 
appropriation  for  the  purchase  of  boolis,  newspapers,  or  periodicals,  or  the 
purchase  of  any  motor-propelled  or  horse-drawn  vehicle  for  carrying  passengers 
or  any  expenses  in  connection  with  the  operation  thereof  is  prohibitetl.  The 
board  prohibits  also  the  hiring  of  such  vehicles  where  the  hiring  by  its  con- 
tinuousness  is  the  equivalent  of  a  purchase. 

45.  Hire  of  taxicabs  and  automobiles. — However,  when  a  person  is  in  a  travel 
status  temporary  hiring  of  vehicles  as  a  means  of  transportation  between  places 
inaccessible  by  common  carrier  is  authorized,  but  when  it  is  found  necessary 
to  temporarily  hire  taxicabs  or  automobiles  the  voucher  should  contain  the 
following  notation,  "  No  other  means  of  transportation  available." 

46.  Purchase  of  books  and  periodicals. — Regarding  the  purchase  of  books 
and  periodicals  the  board  feels  that  resources  of  this  type  should  already  be 
in  the  possession  of  a  State  department  or  board  of  liealth,  and  if  it  should  be- 
found  necessary  to  make  any  additions  thereto  it  should  be  done  with  strictly- 
State  funds  and  vouchers  covering  siich  payments  not  submitted  to  the  board. 

47.  Purchase  of  office  furniture. — The  cost  of  strictly  ofBce  furniture,  sucb. 
as  desks,  chairs,  typewriters,  adding  machines,  electric  fans,  etc.,  is  not  con- 
sidered an  authorized  cliarge  against  these  funds  if  the  articles  are  for  use  in 
the  offices  of  State  boards  or  departments  of  liealth.  The  above  ruling  is  based 
upon  the  wording  of  the  Federal  act  appropriating  these  funds  which  specifies 
that  the  funds  are  to  be  used  for  "  the  prevention,  control,  and  treatment  of 
venereal    diseases." 

The  use  of  these  funds  for  enlargement,  repair,  or  construction  of  buildings 
is  prohibited. 

48.  No  other  State  funds  available.- — However,  if  there  are  no  other  State 
funds  available  from  which  to  make  purchases  of  equipment  necessary  for  the 
successful  prevention,  treatment,  and  control  of  venereal  diseases,  the  matter 
may  be  taken  up  with  the  board  prior  to  incurring  the  liability  and  the  applica- 
tion will  be  given  full  consideration. 

CLASSIFICATION    OF    EXPENDITURES. 

49.  Classification. — Each  voucher  must  be  distributed  under  its  appropriate 
classification,  viz,  "  Administration,"  "  Treatment,"  "  Repressive  measures," 
"  Educational  and  publicity,"  and  the  proi^er  budget  account  number  to  vdiicl* 
the  expenditure  is  chargeable  must  be  given.     Particular  attention  is  directeci 

15G10— 20 15 


226      REPORT  U,  S.  INTERDEPARTMENTAL  SOCIAL  HYGIEiSrE  BOARD. 

to  the  fact  that  care  must  be  used  in  debiting  the  expenditure  to  the  proper 
budget  account  number  tliat  tlie  disbursements  may  be  correctly  charged  against 
tlie  proper  allotment  as  given  on  your  budget  under  "  Activity  or  project."  It 
is  very  necessary  that  account  numbers  be  shown  on  all  vouchers,  as  those  not 
bearing  account  numbers  will  be  returned. 

50.  Account  ledger. — It  is  suggested  that  State  "boards  of  health  keep  an 
account  ledger  in  order  that  they  may  know  at  all  times  the  balance  available 
under  each  of  the  budget  accounts.  The  keeping  of  such  a  book  will  be  very 
necessarj^  beginning  July  1,  1920,  in  order  that  boards  of  health  may  be  in  a 
position  to  submit  quarterly  statement  of  budget  balances  (Form  No.  22) 
promptly  at  the  end  of  each  quarter. 

QUAETEELY  STATEMENT  OF  BUDGET  BALANCES. 

51.  This  form  is  to  be  submitted  to  the  board  in  duplicate  at  the  expiration 
of  each  quarter,  viz,  September  30,  December  31,  March  31,  and  June  30.  '  A 
separate  report  will  be  submitted  for  the  1920  "  Revised  joint  State  and  Federal 
budget "  and  the  1921  "  Joint  State  and  Federal  budget "  in  accordance  with 
instructions  printed  on  the  back  of  the  form.  Upon  receipt  of  this  quarterly 
statement  of  budget  balances  it  will  be  compared  with  the  books--of  the  board. 
Corrections  will  be  entered  in  the  columns  printed  thereon  for  that  purpose 
and  the  duplicate  copy  approved  and  returned  to  the  State  board  of  health, 
thus  keeping  the  State's  record  and  board's  in  agreement.  It  is  believed  that 
this  plan  will  be  found  of  great  advantage  to  the  States  and  will  prevent  the 
overdrawing  of  amounts  allotted  to  the  various  account  numbers  on  the  State 
budget. 

DISPOSITION     OF     VOUCHEES. 

52.  Numhering. — All  paid  vouchers  must  be  retained  in  the  files  of  the  paying 
official  until  the  close  of  the  month  and  then  be  numbered  in  the  space  provided 
therefor  on  the  face,  each  State  commencing  the  1921  series  Avith  No.  1  and 
*continuing  consecutively  until  the  entire  allotment  for  the  fiscal  year  1921  has 
been  disbursed.  However,  for  the  fiscal  years  1919  and  1920,  vouchers  should 
continue  the  present  series  of  numbers  until  the  funds  for  those  fiscal  years- 
have  been  entirely  accounted  for.  The  "brief"  on  the  back  of  the  voucher 
form  should  be  completely  filled  in  by  the  paying  official  before  transmitting 
the  paid  vouchers  to  the  board  for  reimbursement. 

53.  Unused  voucher  numbers. — All  voucher  numbers  must  be  accounted  for, 
and  should  a  voucher  be  canceled  or  a  number  not  used  for  any  reason  a  nota- 
tion to  that  effect  should  be  made  on  the  monthly  report  opposite  the  numbers 
in  question. 

54.  Summarising. — Vouchers  must  be  summarized  on  the  monthly  report  form 
in  numerical  order  and  distributed  thereon  in  accordance  with  the  classification 
shown  on  the  voucher. 

55.  Disposition. — One  copy  of  all  paid  vouchers  must  be  transmitted  monthly^ 
together  Avith  one  copy  of  the  monthly  report  form,  to  the  United  States  Inter- 
departmental Social  Hygiene  Board,  ISOO  Virginia  Avenue  NW.,  Washington, 
D.  C,  and  one  or  more  copies  of  each  retained  in  the  files  of  the  State  depart- 
ment or  board  of  health  or  the  State  official  making  the  payment. 

56.  Registering. — All  vouchers  and  monthly  reports  should  be  forAvarded  to 
the  board  under  registered  cover.  This  may  be  done  Avithout  cost  to  the  depart- 
ments or  boards  of  health  by  having  the  same  registered  as  official  under  the 
■Government  frank. 

57.  Signatitres. — All  vouchers  and  monthly  reports  should  be  carefully  ex- 
amined before  transmitting  them  to  the  lioard  in  order  to  make  sure  that  they 


KEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.      227 

meet  tlie  requirements  of  the  regulations  and  that  all  necessary  signatures  are 
affixed.  Careful  attention  given  to  this  suggestion  may  prevent  vouchers  being 
suspended  or  returned. 

MONTHLY    KEPORT. 

58.  Number  to  be  made. — This  report  shall  be  made  promptly  at  the  close  of 
each  month  and  may  be  prepared  in  duplicate,  triplicate,  or  quadruplicate  in 
accordance  with  the  special  requirements  of  each  State.  All  vouchers  paid  dur- 
ing the  month  for  which  this  report  is  rendered  must  be  summarized  thereon 
ijQ  numerical  order  and  the  amount  paid  distributed  in  accordance  with  the 
classification  given  on  the  voucher.  The  budget-account  number  given  on  the 
voucher  need  not  be  shown  on  this  report. 

59.  Disposition. — One  copy  shall  be  forwarded  to  the  United  States  Interde- 
partmental Social  Hygiene  Board,  1800  Virginia  Avenue  NW.,  Washington, 
D.  C,  accompanied  by  the  paid  vouchers  summai-ized  thereon,  and  one  or  more 
copies  may  be  retained  by  the  State  officials.  It  is  suggested  that  this  report 
be  prepared  on  the  typewriter. 

60.  Report  for  each  budget. — A  monthly  report  should  be  submitted  every 
month  for  each  budget  under  which  there  are  funds  remaining  unaccounted  for. 

61.  Last  day  for  forioarding  vovA^liers  and  monthly  reports. — Monthly  re- 
ports and  vouchers  should  be  forwarded  as  soon  after  the  close  of  a  month  as 
possible  and  must  reach  Washington  not  later  than  the  25th  of  the  month  fol- 
lowing that  covered  by  the  report. 

62.  Where  no  disbursements  are  made. — If  no  expenditures  are  made  dur- 
ing a  month,  a  monthly  report  should  be  forwarded  any  way  with  the  notation 
thereon,  "*No  disbursements  made." 

SUMMARY    RECORDED    ON    MONTHLY    REPORTS. 

63.  Before  transmitting  the  monthly  report  to  the  board,  the  summary  on  the 
back  of  the  same  must  be  properly  filled  out,  in  accordance  with  the  printed  in- 
structions thereon. 

The  summary  should  represent  the  joint  State  and  Federal  account  and  be- 
gin with  the  total  of  both  the  State  appropriations  and  the  Federal  allotment  as 
shown  on  your  budget.  The  total  disbursements  of  the  two  funds  during  a 
month,  as  shown  on  the  face  of  the  report,  is  to  be  deducted,  and  the  balance 
remaining  will  be  the  "  available  balance  for  the  continuance  of  the  work.'' 
Repayments  made  by  Federal  Government  are  not  to  be  considered  in  making 
this  summary. 

64.  Interest,  fees,  and  sales. — Money  received  on  account  of  interest  on  bank 
deposits,  sale  of  medicines,  fees,  etc.,  should  be  taken  up  in  the  summary  on  the 
back  of  the  proper  monthly  report  by  a  special  entry  and  the  Board  advised  by 
letter  as  to  the  budget-account  number  to  which  the  funds  have  been  credited 
by  the  State. 

Interest  should  be  taken  up  immediately  upon  the  receipt  of  notification  from 
the  bank  as  to  tlie  amount  of  interest  credited.  Receipts  from  the  sale  of 
arsphenamine  and  other  medicines  or  fees  received  for  treatment  should  be 
taken  up  monthly  and  credited  to  the  budget-account  number  charged  with 
the  original  expenditure'. 

STATE  LAWS. 

65.  These  rules  shall  not  in  any  way  conflict  witli  State  laws  or  prevent 
State  accounting  departments  from  requiring  such  vouchers,  receipts,  and 
other  records  as  may  be  necessary  to  comply  with  the  State  laws  or  the  State's 
accounting  system. 


228      EEPOET  U.  S.  INTEKDEPAETMENTAL  SOCIAL  HYGIENE  BOARD. 

CONCLUSION. 

66.  In  conclusion,  the  board  desires  to  thanlv  all  State  officials  for  their  hearty- 
cooperation  in  the  past  and  to  assure  them  that  these  rules  and  regulations  for 
disbursing  the  joint  State  and  Federal  funds  will  present  no  obstacle  either  in 
connection  with  State  laws  or  the  manner  in  which  State  appropriations  may^ 
be  made  that  can  not  be  overcome,  and  the  very  liberal  Federal  assistance  shoald 
be  well  worth  the  little  extra  clerical  labor  required  by  these  regulations.  How- 
ever, should  any  State  official  find  it  difficult  to  comply  with  these  regulations,, 
it  is  suggested  that  the  matter  be  taken  up  promptly  with  the  United  States 
Interdepartmental  Social  Hygiene  Board,  but  this  suggestion  is  not  made  antici- 
pating that  it  may  be  advisable  in  any  case  to  modify  these  regulations,  and  it  is 
not  the  present  intention  of  the  board  to  do  so  unless  they  should  conflict  witk 
State  laws. 

It  is  the  desire  of  the  Interdepartmental  Social  Hygiene  Board  to  fully  co- 
operate with  each  State  and  assist  in  every  way  possible  within  the  limitations 
of  its  responsibilities  and  in  accordance  with  the  laws  and  regulations  surround- 
ing the  disbursing  of  Government  funds. 

All  correspondence  in  connection  with  these  regulations  or  the  Chamber- 
lain-Kahn  funds  to  be  addressed  to  the  Executive  Secretary  of  the  Board,  1800 
Virginia  Avenue  NW.,  Washington,  D.  O. 

T.  A.  Stokey, 
Executive  Secretary, 
United  States  Interdepartmental  Social  Hygiene  Board. 
Approved : 

0.  C.  Pierce, 

Assistant  Surgeon  General, 

United  States  Public  Health  Service. 


APPENDIX  E. 

1.  REGULATIONS  GOVERNING  THE  SCIENTIFIC  RESEARCH  FUND,i 

1919-20. 

The  United  States  Interdepartmeutal  Social  Hygiene  Board  prescribes  the 
following  rules  and  regulations  in  conformity  with  that  part  of  section  6, 
Chapter  XV,  Public  193,  Sixty-fifth  Congress,  which  provides  that  the  sum  of 
$100,000  "  shall  be  paid  to  such  universities,  colleges,  or  other  suitable  institu- 
tions as  in  the  judgment  of  the  Interdepartmental  Social  Hygiene  Board  are 
•qualified  for  scientific  research  for  the  purpose  of  discovering,  in  accordance 
with  the  rules  and  regulations  prescribed  by  the  Interdepartmental  Social 
Hygiene  Board,  more  effective  medical  measures  in  the  treatment  and  preven- 
tion of  venereal  diseases." 

1.  Appropriations  from  this  fund  wih  be  made  only  to  universities,  colleges, 
or  other  suitable  institutions  that  give  satisfactory  evidence  of  possessing  a  staff 
of  scientific  experts  and  an  equipment  of  scientific  apparatus,  supplies,  and  re- 
sources that  will  guarantee  that  the  researches  undertaken  will  be  carried  out 
under  approved  scientific  conditions  and  in  conformity  with  scientific  methods. 

2.  Appropriations  from  this  fund  for  scientific  research  will  be  made  only  for 
•definite  investigations  that  are  described  by  the  proposers  in  sufficient  detail 
to  satisfy  the  Interdepartmental  Social  Hygiene  Board  that  there  is  a  justifi- 
able expectation  that  these  researches  "will  discover  more  effective  medical 
measures  in  the  prevention  and  treatment  of  venereal  diseases." 

3.  The  universities,  colleges,  or  other  institutions  proposing  researches  and 
asking  for  appropriations  will  furnish  information  on  the  following  subjects : 

(a)  Name  of  institution  requesting  appropriation. 

(b)  Name,  office,  and  address  of  official  representative  of  this  institution. 

(c)  Title  concisely  descriptive  of  research  proposed. 

(d)  Laboratory  in  which  research  is  to  be  carried  out. 

(e)  List  of  more  important  scientific  publications  from  this  laboratory. 

if)  Name  and  concise  statement  of  the  scientific  training  of  the  laboratory  ' 
•chief  or  director,  or  other  individual  responsible  for  the  scientific  policy  of  the 
laboratory. 

(g)  Laboratory  staff,  giving  names,  degrees,  etc. 

(h)  Laboratory  equipment  and  facilities,  with  a  concise  statement  indicating 
scientific  and  working  capacity  of  the  laboratory,  and  cooperating  laboratories, 
■departments,  and  agencies. 

(i)  Description  of  research  proposed;  outline  plan  in  sufficient  detail  to  show 
clearly  its  scientific  character  and  justify  the  expectation  that  it  will  discover 
"  more  effective  medical  measures  in  the  prevention  and  treatment  of  venereal 
diseases."  Include  references  to  important  scientific  literature  bearing  on  re- 
search proposed. 

(;■)  Probable  cost.  Give  general  items  covering  the  necessary  equipment  and 
supplies,  with  an  estimate  of  the  probable  cost  of  preparing  and  printing  a 

1  See  sec.  6,  Chap.  XV.  Public  No.  193,  65th  Cong.,  Army  appropriation  bill  of  July  9, 
1918. 

229 


230      REPOKT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOAED. 

report.  Should  not  include  the  salaries  of  scientific  investigators,  but  may 
include  salaries  for  technical  assistants. 

(k)  Will  this  institution  be  able  to  carry  on  the  research  proposed  if  it  re- 
ceives no  financial  aid  from  the  Interdepartmental  Social  Hygiene  Board? 

4.  Universities,  colleges,  and  other  institutions  asking  for  appropriations  will 
furnish  the  board  -with  a  budget  made  out  on  forms  supplied  by  the  board  and 
will  make  an  accounting  of  their  disbursements  in  conformity  with  the  rules 
of  the  Comptroller  of  the  Treasury  of  the  United  States  Government. 

2.  APPLICATION   FORM   FOR  ASSISTANCE   IN    SCIENTIFIC 

RESEARCH. 

Application  for  appropriations  to  "  universities,  colleges,  or  other  suitable 
institutions,  for  the  purpose  of  discovering,  in  accordance  with  the  rules  and 
regulations  prescribed  by  the  United  States  Interdepartmental  Social  Hygiene 
Board,  more  effective  medical  measures  in  the  treatment  and  prevention  of 
venereal  diseases."  ^ 

[Form  for  1920-21  appropriations.] 

Date  of  application  :  • . 


(1)  Name  of  institution  requesting  appropriation. 

(2)  Name,  position,  and  address  of  official  representative  of  the  institution. 

(3)  Title  concisely  descriptive  of  research  proposed. 

(4)  Laboratory  in  which  research  is  to  be  carried  on. 

(5)  List  of  more  important  scientific  publications  from  this  laboratory. 
(May  be  appended.) 

(6)  Name  and  concise  statement  of  the  scientific  training  of  the  laboratory 
chief,  or  director,  or  other  individual  responsible  for  the  scientific  policy  of  the 
laboratory. 

(7)  Laboratory  staff,  giving  names,  degrees,  positions,  etc.  (May  be  ap- 
pended. ) 

(8)  Name  of  individual  to  be  in  charge  of  the  research  and  names  of  men 
and  women  working  with  him. 

(9)  Laboratory  equipment  and  facilities,  with  a  concise  statement  indicating 
scientific  and  working  capacity  of  the  laboratory,  cooperating  laboratories, 
departments,  and  agencies.  Send  catalogue  or  register  describing  work  of 
the  department  in  which  this  laboratory  is  located. 

(10)  Description  of  research  proposed:  Outline  plan  and  method  of  investi- 
gation in  sufficient  detail  to  show  clearly  its  scientific  character  and  justify 
the  expectation  that  it  will  discover  "  more  effective  medical  measures  in  the 
prevention  and  treatment  of  venereal  diseases."  (Description  may  be  ap- 
pended. ) 

(11)  How  soon  will  this  research  begin  after  appropriation  is  received? 
How  long  is  it  estimated  that  it  will  take  to  complete  the  investigation? 

(12)  Include  references  to  important  scientific  literature  bearing  upon  the 
research  proposed.     (May  be  appended.) 

(13)  Probable  cost.  Give  general  items  covering  necessary  salaries,  equip- 
ment, supplies,  etc.,  and  the  probable  cost  of  preparing  and  printing  a  report, 
500  copies  of  which  are  to  be  placed  with  the  United  States  Interdepartmental 
Social  Hj'giene  Board  without  further  cost  to  the  board. 

1  To  be  made  in  triplicate ;  one  copy  to  be  kept  by  the  ofBcial  representative  of  the 
institution. 


REPORT  V.  S.  IXTERDEPARTMEKTAL  SOCIAL  HYGIENE  BOARD.     231 

o)  Salaries  (including  compensation  for  estimated  actual  time  to  ))e 
spent  in  connection  with  this  proposed  research  by  scientific  in- 
vestigators, clerks,  janitors,  etc.,  and  estimated  full  time  of  such 
technical  assistants,  and  others,  as  may  be  employed  entirely  on 
this  proposed  investigation.     These  positions  to  be  itemized  as 

fully  as  practicable) ^ $ 

(h)  Equipment  (including  such  laboratory  equipment  as  may  be 
necessary  for  properly  conducting  the  proposed  investigation). 
Do  not  itemize  in  detail 

(c)  Supplies  (including  chemicals,  glass,  animals,  feed,  etc.).     Do  not 

itemize  in  detail 

(d)  Incidentals   (including  travel  expenses,  car  fare,  freight,  and  ex- 

press, postage,  etc.,  specifically  related  and  essential  to  the  re- 
search proposed).     Do  not  itemize  in  detail 

(e)  Report   (cost  of  preparing  and  printing  a  report  covering  the  re- 

sults of  the  proposed  research) 


Total ', 

(14)  Will  the  institution  be  able  to  carry  on  the  research  proposed  if  it 
receives  no  aid  from  the  United  States  Interdepartmental  Social  Hygiene  Board 
or  some  other  outside  source? 

(15)  On  the  basis  of  the  above  presentation,  I, ,  the  under- 
signed, being  the  duly  authorized  and  competent  agent  of  the  ,  in  the 

city  of ,  do  agree  that  a  research  entitled  ■ —  Avill  be  carried  on  in 

this  institution  under  the  direction  of  ■ ,  and  in  the  laboratory  of 

,  in  accord  with  the  plans  described  above,  and  I  agree  that  every  reason- 
able effort  will  be  made  by  this  institution  to  bring  this  research  to  a  conclu- 
sion that  will  discover  or  lead  to  the  discovery  of  a  better  method  for  the 

prevention  or  treatment  of  and  that  the  shall  furnish  for  this 

purpose  the  sum  of —  dollars  for  this  research :  Provided,  That  the  United 

States  Interdepartmental  Social  Hygiene  Board  shall  allot  to  this  institution 

the  sum  of dollars  for  the  same  purpose,  and  I  further  agree  that  the 

will  submit  a  budget  of  proposed  expenditures  to  be  paid  from  the  joint 

fund  thus  established,  and  that  it  will  transmit  monthly  a  sworn  statement  of 
its  disbursements  therefrom  in  accordance  with  instructions  to  be  provided  and 
upon  forms  to  be  supplied  by  the  United  States  Interdepartmental  Social 
Hygiene  Board,  and  that  it  will  report  the  progress  of  its  research  activities 
quarterly  (December,  March,  June,  and  September),  and  that  it  will  prepare 
and  have  printed  without  further  cost  to  the  board  a  final  report  covering  the 
completed  research,  and  that  five  hundred  (500)  copies  of  this  report  will  be  fur- 
nished the  Interdepartmental  Social  Hygiene  Board  without  additional  cost  to 
the  board.  I  further  agree  that  this  institution  will  furnish  in  duplicate  a 
certified  copy  of  the  official  action  taken  by  the  duly  constituted  authorities  of 
this  institution  showing  that  this  institution  has  set  aside  a  sum  for  the  dis- 
covery of  more  effective  methods  in  the  prevention  and  treatment  of  the 
venereal  diseases  at  least  equal  to  the  amount  to  be  received  from  the  United 
States  Interdepartmental  Social  Hygiene  Board. 

Signature :    

Representing  the 

Approved :  

Executive  Secretary,  — 

Interdepartmental  Social  Hygiene  Board. 

Date  approved  by  executive  committee : 

Date  approved  by  United  States  Interdepartmental  Social  Hygiene  Board : 


Appendix  F. 

<1.)    REGULATIONS    GOVERNING   THE   EDUCATIONAL  RESEARCH 
AND  DEVELOPMENT  FUND.i 

[Proposed  revision  for  1920-21.] 

Allotment  from  Appeopeiations  Made  foe  the  Fiscal  Yeaes  1919  and  1920. 

The  Sixty-fifth  Congress  appropriated  the  sum  of  $300,000  for  each  of  the 
iiscal  years  1919  and  1920,  to  be  paid  to  such  universities,  colleges,  or  other 
suitable  institutions  or  organizations  as  in  the  judgment  of  the  United  States 
Interdepartmental  Social  Hygiene  Board  are  qualified  for  scientific  research, 
■for  the  purpose  of  discovering  and  developing,  in  accordance  with  the  rules  and 
regulations  prescribed  by  the  United  States  Interdepartmental  Social  Hygiene 
Board,  more  effective  educational  measures  in  the  prevention  of  venereal  dis- 
eases, and  for,  the  purpose  of  sociological  and  psychological  research  related 
thereto. 


geneeal  eegulations  governing  allotments. 

The  United  States  Interdepartmental  Social  Hygiene  Board  prescribes  the 
following  rules  and  regulations  governing  allotments  in  conformity  with  sec- 
tion 6,  Chapter  XV,  Public  193,  Sixty-fifth  Congress : 

1.  Allotments  will  be  made  from  this,  the  "  educational  research  and  develop- 
ment fund,"  only  to  universities,  colleges,  or  other  institutions  that  give  satis- 
factory evidence  of  administrative  responsibility,  educational  effectiveness,  and 
scientific  standards  that  will  not  depend  on  the  support  of  the  United  States 
Interdepartmental  Social  Hygiene  Board  for  their  continuity. 

2.  Proposals  for  assistance  will  be  favored  from  established  normal  schools, 
colleges,  and  universities  which  exhibit  understanding  and  appreciation  of  the 
significance  of  hygiene  in  the  educative  process ;  especially  from  such  normal 
schools,  colleges,  and  universities  as  are  concerned  with  the  development  of  more 
effective  methods  of  educating  teachers  in  training. 

3.  The  board  in  general  will  favor  the  development  of  educational  methods 
under  this  appropriation  that  combine  instruction  and  training  for  the  preven- 
tion of  venereal  diseases  in  a  wise  proportion  with  and  relation  to  instruction 
and  training  along  other  intimate  and  nearly  related  lines  of  hygiene. 

SOCIOLOGICAL   AND   PSYCHOLOGICAL  EESEAKCH. 

4.  For  the  purpose  of  "  discovering  more  effective  educational  measures  in 
the  prevention  of  venereal  diseases "  appropriations  will  be  made  from  the 
funds  of  the  board  for  such  special  researches  as  may  be  proposed  to  and 
approved  by  the  board  under  the  rules  and  regulations  laid  down  above  and 
under  the  rules  and  regulations  laid  down  for  the  allotment  of  appropriations 
from  the  scientific  research  fund. 

1  See  sec.  6,  Chap.  XV,  Public  193,  65th  Cong.,  Army  appropriation  bill,  July  9,  1918. 
232 


HEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     233 

ESTABLISHMENT    OF   DEPARTMENTS    OF    HYGIENE. 

5.  For  the  purpose  of  developing  more  effective  eflucationnl  measures  in  the 
prevention  of  venereal  diseases  allotments  will  be  made  from  the  educational 
■research  and  development  fund  to  normal  schools,  colleges,  and  universities, 
and  especially  to  the  chief  normal  training  schools  or  college  training  schools 
jCor  teachers  in  the  several  States,  to  assist  such  normal  schools,  colleges,  and 
universities  in  organizing  or  completing  the  organization  of  departments  of 
hygiene,  the  curriculum  of  which  shall  include  course  and  conferences  in 
informational  hygiene,  and  courses,  conferences,  and  training  in  the  application 
of  hygiene,  emphasizing  with  appropriate  and  due  proportion  and  with  proper 
tact  and  persistency  the  serious  importance  of  venereal  diseases,  their  causes, 
carriers,  and  prevention ;  and  emphasizing  at  the  same  time  the  other  important 
facts  and  applications  of  general  hygiene,  individual  hygiene,  group  hygiene, 
.and  intergroup  hygiene. 

DEPAKTMENTAL   OBGANIZATION. 

6.  In  general  the  departmental  organization  contemplated  by  the  board  is 
outlined  below : 

The  integrated  organization  of  all  the  hygienic  factors  and  resources  of  the 
institution  is  the  form  of  organization  which,  as  demonstrated  by  experience, 
guarantees  largest  results.  It  is  recognized,  however,  that  each  institution 
has  its  own  administrative  traditions  and  administrative  problems.  Bach 
institution  receiving  aid  from  this  fund  will  be  expected,  therefore,  to  bring 
about  equal  efficiency  of  all  the  factors  in  the  departmental  program  as  outlined 
and  to  realize  as  completely  and  rapidly  as  possible  the  benefits  of  unified 
-organization  in  accordance  with  its  own  traditions  and  its  own  special  con- 
ditions. 

I.  Division  of  informational  hygiene.- — (Stressing  in  each  of  its  several  divi- 
sions with  due  proportion  and  with  appropriate  emphasis,  the  venereal  diseases, 
their  causes,  carriers,  injuries,  and  prevention.) 

(a)  The  principles  of  hygiene.  Required  of  all  students  at  least  twice  a 
"week  for  at  least  four  semesters. 

(1)  General  hygiene  (the  agents  that  injure  health,  the  carriers  of  disease, 
the  contributory  causes  of  poor  health,  the  defenses  of  health,  and  the  sources 
of  health). 

(2)  Individual  hygiene  (informational  hygiene,  the  care  of  the  body  and  its 
organs,  correction,  and  repair,  preventive  hygiene,  constructive  hygiene). 

(3)  Group  hygiene  (hygiene  of  the  home  and  tlie  family,  school  hygiene,  occu- 
pational hygiene). 

(4)  Intergroup  hygiene  (interfamily,  community,  intercommunity.  State, 
Interstate,  and  international  hygiene). 

(&)  Principles  of  physical  training  (i.  e.,  gymnastics,  exercise,  athletics,  re- 
•creation,  and  play).  The  physiological,  developmental,  and  social  significance 
of  physical  training.  Required  of  all  students  preparing  as  teachers.  To  be 
given  at  least  twice  a  week  for-  one  semester,  preferably  in  the  junior  or  senior 
years. 

(c)  Health  examinations : 

(1)  Medical  examination  (making  reasonable  provisions  for  a  private,  per- 
sonal, confidential  relationship  between  the  examiner  and  the  student). 

(2)  Sanitary  surveys  and  hygiene  inspections  applied  regularly  to  all  divisions 
of  the  institutions,  their  curriculums,  buildings,  dormitories,  equipment,  per- 
gonal service,  and  surroundings. 


234      EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD. 

II.  Division  of  applied  hygiene. — 
(a)   Health  conference. 

(1)  Every  student  advised  under  (c)  above  (health  examinations)  must 
report  to  his  health  examiner  within  a  reasonable  time,  as  directed,  with  evi- 
dence that  he  has  followed  the  advice  given,  or  with  a  satisfactory  explanation 
for  not  having  done  so. 

(2)  Must  provide  student  with  opportunities  for  safe,  confidential  consulta- 
tions with  competent  medical  advisors  concerning  the  intimate  problems  of  sex 
life  as  well  as  those  of  hygiene  in  general. 

(&)  Physical  training.  One  hour  daily  each  school  day  required  of  all 
students. 

(1)  Gymnastic  exercises,  recreation,  games,  athletics,  and  competitive  sports. 

(2)  Reconstructional  and  special  training  and  exercise  for  students  not 
qualified  organically  for  the  regular  activities  covered  in  (1)  above.  It  is  as- 
sumed that  every  student,  and  especially  every  teacher  in  training  physically 
able  to  go  to  school,  is  entitled  to  and  should  take  some  form  of  physical  exercise.. 

III.  Division  of  records  and  planning. — 

(a)  Investigations,  tests,  evaluating  measurements,  records,  and  reports  re- 
quired each  term  covering  progress  made  under  each  division  and  subdivision 
of  the  department,  for  the  purpose  of  discovering  and  developing  more  effective 
educational  methods  in  hygiene. 

(6)  Provide  facilities  for  the  sifting,  selection,  and  investigation  of  problems 
in  hygiene  that  may  be  submitted  to  or  proposed  by  the  department  of  hygiene. 

(c)  Arrange  for  occasional  lectures  on  public  hygiene  and  public  health  from 
competent  members  of  municipal.  State,  and  national  departments  of  health,  and 
from  other  appropriate  sources. 

IV.  Personnel  requisite  for  such  a,  department. — Men  and  women  should  be 
chosen  for  service  in  the  several  divisions  of  the  department  who  have  a  sane, 
well-balanced,  and  experienced  appreciation  of  the  importance  of  the  whole 
field  of  hygiene,  as  well  as  of  the  place  and  relations  of  the  venereal  diseases. 

(1)  Director:  Must  have  satisfactory  scientific  training  and  special  expe- 
rience, fitting  him  for  supervision,  leadership,  teaching,  research,  and  admin- 
istrative responsibility. 

(2)  Teachers  of  hygiene:  To  be  selected  with  special  reference  to  their  whole- 
some influence  on  students  and  because  of  their  ability  to  make  successful  use 
of  their  peculiar  opportunities  to  emphasize  appropriately  and  with  due  propor- 
tion, proper  tact,  and  with  persistency  the  serious  importance  of  the  venereal 
diseases,  their  causes,  carriers,  injuries,  and  prevention,  and  emphasizing  at 
the  same  time  the  other  important  facts  and  applications  of  general,  individual, 
group,  and  intergroup  hygiene. 

(3)  Teachers  of  physical  training:  There  should  be  not  less  than  one  teacher 
of  physical  training  for  each  group  of  300  students.  There  must  be  men  teach- 
ers for  the  men  and  women  teachers  for  the  women  students.  The  physical- 
training  instructors  employed  in  this  department  should  be  in  charge  of  and 
should  cover  satisfactorily  all  the  directing,  tra-ining,  and  coaching  carried  on 
in  the  department  and  in  the  institution  in  its  relation  to  athletics  and  com- 
petitive sports.  The  men  and  women  who  are  placed  in  charge  of  individual  stu- 
dents and  groups  of  students  engaged  in  the  various  activities  of  physical 
training  (gymnastics,  athletics,  recreation,  and  play)  should  be  selected  with 
special  reference  to  their  wholesome  influence  on  young  men  and  young  women. 

(4)  Health  examiners  for  men  and  health  examiners  for  women:  There 
should  be  not  less  than  one  examiner  for  each  500  students.  Must  be  selected 
with  special  care  because  of  extraordinary  opportunities  to  exercise  powerful 


KEPOKT  U.  S.  INTEKDEPAETMENTAL  SOCIAL  HYGIENE  BOARD.     235 

intimate  influence  upon  tlie  mental,  moral,  and  physical  health  of  the  students 
with  whom  such  examiners  come  in  contact. 

(5)  Clerical  and  stenographic  service  to  meet  the  needs  of  the  department. 

(6)  Special  lectures  on  the  principles  and  progress  of  public  hygiene  and 
public  healtli.  A  close  coordination  should  be  secured  between  this  department 
and  community  agencies  like  the  department  of  liealth  that  are  concerned  with 
public  hygiene. 

7.  For  the  purpose  of  eslablishing  such  a  department  in  a  normal  school, 
college,  or  university,  the  United  States  Interdepartmental  Social  Hygiene 
Board  will  furnish  financial  assistance  for  necessary  personal  service.  Origi- 
nal application  for  sucli  assistance  should  be  approved  by  the  chief  educational 
authority  of  the  State  concerned. 

8.  In  order  to  secure  such  an  allotment,  the  normal  school,  college,  or  uni- 
versity applying  for  such  assistance  shall  furnish  the  United  States  Interde- 
partmental Social  Hya'iene  Board  with  all  necessary  information  and  shall  give 
the  board  satisfactory  assurance  that  there  will  be  organized  a  department  and 
a  program  of  hygiene  in  general  conformity  with  the  plans  of  the  board. 

9.  The  normal  school,  college,  or  university  to  which  allotments  are  made 
by  the  board  will  furnish  the  board  with  a  budget  covering  its  probable  ex- 
penses for  personal  service  on  forms  supplied  by  the  board,  and  will  make 
an  accounting  of  their  disbursements  in  conformity  with  the  rules  of  the  United 
States  Interdepartmental  Social  Hygiene  Board  governing  expenditures  from 
this  fund.  (Details  relative  to  application  will  be  found  below  under  title 
"Form  of  application  for  allotment.") 

II. 

EEGULATIONS  GOVERNING  PAYMENTS  OF  ALLOTMENTS  FOE  DEPAETMENTS  OF  HYGIENE. 

The  $300,000  appropriations  for  the  two  fiscal  years  of  1919  and  1920  as 
provided  by  Congress  were  not  conditioned  upon  the  universities,  colleges,  or 
other  institutions  or  organizations  setting  aside  or  contributing  any  special 
amount,  and  in  order  to  expedite  the  commencing  of  the  work  the  board  thought 
it  advisable  at  that  time  to  pay  the  allotments  in  full  in  a  lump  sum  to  be 
expended  by  the  recipient,  subject  to  a  budget  submitted  to  and  approved  by 
the  board  and  in  accordance  with  certain  accounting  instructions. 

For  the  fiscal  year  1921  Congress  reduced  its  appropriation  to  $250,000,  and 
also  added  the  following  proviso  : 

"  No  part  of  the  sum  contained  in  the  preceding  paragraph  shall  be  paid  tO' 
any  university,  college,  or  other  institution  or  organization  which  does  not  set 
aside  an  additional  sum  for  the  same  purpose  at  least  equal  to  the  amount  to- 
be  received  from  the  United  States." 

On  account  of  the  above  proviso,  a  different  procedure  in  paying  all  future 
allotments  to  be  made  from  this  fund  is  found  to  be  necessary. 

In  accordance  with  the  wording  of  the  appropriation  as  made  by  Congress, 
the  board  has  ruled  that  in  order  to  qualify  for  an  allotment  a  university^ 
college,  or  other  institution  or  organization  otherwise  meeting  the  requirements 
as  specified  in  the  regulations  governing  allotments  must  in  addition  set  aside 
or  agree  to  set  aside  a  sum  for  the  same  purpose  at  least  equal  to  the  allotment 
to  be  received  from  the  United  States  Interdepartmental  Social  Hygiene  Board. 
The  Comptroller  of  the  United  States  Treasury  has  ruled  that  buildings,  equip- 
ment, or  other  estimated  values  can  not  be  accepted  as  complying  in  whole  or 
in  part  with  the  requirements  specified  by  Congress  in  the  appropriation  act. 
However,  when  a  university,  college,  or  other  suitable  institution  or  organiza- 


236      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL,  HYGIENE  BOARD. 

tion  qualifies  under  the  regulations  approved  by  the  board  for  an  allotment 
from  the  appropriation  for  the  fiscal  year  1921  the  board  will  not  require  the 
depositing  of  the  funds  in  any  special  account  with  a  bank  or  other  depository, 
but  will  accept  evidence  of  the  institution's  willingness  to  meet  the  obligation, 
and  will  enter  into  a  written  agreement  with  the  institution  whereby  it  will 
bind  itself  to  fully  comply  with  the  act  of  Congress  by  agreeing:  (1)  To  "set 
aside  an  additional  sum  for  the  same  purpose  at  least  equal  to  the  amount  to 
t)e  received  from  the  United  States,"  and  (2)  to  furnish  in  duplicate  a  certified 
copy  of  the  oflicial  action  on  the  part  of  the  institution  showing  that  it  has 
a  department  of  hygiene  and  that  it  has  set  aside  such  additional  amount.  In 
view  of  the  fact  that  the  board  accepts  this  agreement  as  complying  with  the 
act  of  Congress,  it  has  revised  somewhat  its  method  of  payment  as  follows : 

The  50-50  plan. — The  practice  of  a  raimber  of  Government  departments  and 
independent  establishments  charged  with  expending  Federal  appropriations 
made  for  allotment  to  States  and  institutions  conditioned  upon  the  matching 
of  dollar  for  dollar  is  to  require  the  State  or  institution  to  first  make  the  dis- 
bursements from  its  own  appropriation,  submitting  the  paid  vouchers  for  audit. 
The  Government  department  then  pays  the  State  or  institution  50  per  cent  of 
such  expenditures  as  may  be  found  to  be  correct.  This  procedure  serves  the 
double  purpose  of  knowing  the  disbursements  made  are  in  accordance  with  the 
approved  budget  and  regulations  governing  the  disbursements  and  that  the 
State  or  institution  complied  with  the  Federal  law  by  not  only  appropriating 
or  setting  aside  an  equal  amount  but  by  actually  expending  from  its  own 
resources  dollar  for  dollar. 

Tlie  50-50  plan  adopted  hy  the  hoard  for  1921. — The  United  States  Interde- 
partmental Social  Hygiene  Board  has  adopted  this  plan  for  disbursing  the 
allotments  to  be  made  to  universities,  colleges,  and  other  institutions  or  organi- 
zations from  the  "  educational  research  and  development  fund  "  appropriated 
by  Congress  for  the  fiscal  j^ear  ending  June  30,  1921.  It  will,  therefore,  be 
necessary  for  institutions  reporting"  disbursements  from  the  joint  account  com- 
posed of  the  allotment  given  by  the  board  and  funds  contributed  by  the  insti- 
tution to  forward  to  the  board  promptly  at  the  close  of  each  month  on  forms 
to  be  furnished  for  that  purpose  an  itemized  monthly  report  of  disbursements, 
properly  executed  in  accoixlance  with  the  "  instructions  for  reporting  expendi- 
tures from  allotments"  (Part  III).  In  the  absence  of  receipted  individual 
vouchers,  it  is  required  that  this  report  be  sworn  to  before  a  notary  public 
before  transmitting  the  same  to  the  board.  Upon  the  receipt  of  this  itemized 
statement  of  disbursements  the  board  will  promptly  audit  the  same  in  accord- 
ance with  the  approved  budget,  and  a  Treasury  warrant  payable  to  the  institu- 
tion submitting  the  account  will  be  drawn  covering  50  per  cent  of  the  total 
disbursements  found  to  be  correct.  The  board  wishes  to  assure  the  institutions 
there  will  be  no  delay  on  its  part  in  making  payment. 

Disbursements  made  from  the  joint  fund  and  not  found  to  comply  with  the 
regulations  or  the  approved  budget  will  be  disallowed  or  suspended  pending  the 
receipt  of  further  information  and  50  per  cent  of  the  remaining  amount  will 
be  immediately  paid. 

Suspended  disbursements. — Any  item  suspended  on  a  monthly  report  of  ex- 
penditures pending  further  information  may  be  resubmitted  on  the  following 
month's  account  for  50  per  cent  reimbursement  by  listing  as  the  last  entry  in 
memorandum  form ;  that  is,  the  entry  should  be  given  the  original  date  of  pay- 
ment, but  the  amount  not  added  in  with  the  expenditures  for  the  current  month, 
inasmuch  as  it  was  previously  deducted  from  the  available  balance  as  shown 
in  the  summary  on  the  back  of  the  monthly  report  when  originally  submitted 
:for  audit. 


KEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL* HYGIENE  BOARD.      237 

in. 

INSTRUCTIONS  FOR  REPORTING  KXPENDITrRKS  FROM    ALL()T^rENTS. 

After  an  allotment  is  made  to  an  institution  a  supply  of  monthly  report  forms 
will  be  furnished  for  reporting  monthly  disbursements  from  the  joint  fund 
provided  by  the  institution  and  the  United  States  Interdepartmental  Social  Hy- 
giene Board  for  establishing  a  department  of  hygiene. 

This  form  should  be  prepared  in  duplicate  promptly  upon  the  close  of  each 
month.  One  copy  of  the  report  to  be  forwarded  to  the  United  States  Interde- 
partmental Social  Hygiene  Board  in  Washington,  D.  C,  and  one  to  be  retained 
in  the  files  of  the  institution. 

The  report  should  be  full  and  concise,  and  be  sworn  to  before  a  notary  public. 

In  reporting  expenditures  on  this  form  attenton  is  directed  to  the  following : 

{a)  The  report  should  be  made  to  cover  all  disbursements  made  from  the 
joint  fund ;  that  is,  from  the  funds  furnished  by  the  institution  as  well  as  the 
funds  allotted  by  the  board.    Only  personal  services  should  be  reported. 

(b)  Fill  in  name  and  the  location  of  the  institution  and  also  show  the  month 
the  report  is  made  to  cover. 

(c)  Insert  in  the  spaces  provided  in  the  upper  right-hand  side  of  the  form 
"Amount  furnished  by  institution,"  "Amount  furnished  by  the  United  States 
Interdepartmental  Social  Hygiene  Board,"  and  "  Total  fund." 

{(I)  "  Date  of  payment  "  should  be  the  date  payment  is  actually  made  or  the 
check  drawn.    These  entries  should  be  made  in  chronological  order. 

(e)  "Name  of  payee":  If  a  salary  payment,  should  also  state  title,  or  the 
position,  as  described  on  the  budget. 

if)  "  Purpose  for  which  paid  " :  If  a  salary  payment,  should  state  the  month 
or  period  "  from  and  to  "  for  which  payment  is  made  and  the  rate  of  com- 
pensation in  order  that  it  may  be  properly  audited. 

{g)  "  Budget  item  number  " :  In  this  space  there  should  be  placed  the  item 
number  as  given  on  the  budget  and  against  which  the  expenditure  is  properly 
chargeable,  as  follows : 

(h)  Item  1,  director;  item  2,  teachers  of  hygiene;  item  3,  teachers  of  physical 
training ;  item  4,  health  examiner ;  item  5,  clerical  and  stenographic  services ; 
item  6,  special  public  health  lectures.  (See  also  application  under  "Budgetary 
forecast.") 

(i)  Attention  is  directed  to  the  "  Summary  "  on  the  back  of  the  report.  This 
summary  is  to  be  completed  by  the  institution  before  forwarding  the  report  to 
the  board  and  should  at  all  times  be  in  agreement  with  the  books  of  both  the 
institution  and  the  board. 

The  summary  represents  the  joint  institution  and  Federal  account  and  should 
begin  with  the  total  of  both  the  institution's  appropriation  and  the  Federal 
allotment.  The  amounts  to  be  given  under  the  budget  item  Nos.  1  to  6,  inclusive, 
are  to  be  taken  from  the  joint  budget  as  approved  by  the  board.  The  disburse- 
ments of  the  joint  fund  during  a  month,  as  shown  on  the  face  of  the  report,  are 
to  be  deducted  from  the  amounts  provided  under  the  item  numbers  and  the 
balances  remaining  will  be  the  amount  available  for  the  continuation  of  work. 

{})  Attention  is  also  directed  to  the  "Note,"  in  italics,  which  directs  that 
should  no  disbursements  be  made  during  a  month,  report  should  carry  the  state- 
ment "  No  disbursements  made."  This  is  necessary  in  order  that  the  board 
may  be  in  a  position  to  know  whether  reports  have  been  lost  in  transmission 
through  the  mail. 


238      REPORT  U.  S.  INl^ERDEPARTMENTAL  SOCIAL  HYGIEIsTE  BOARD. 

Care  should  be  used  in  preparing  these  reports  and  the  same  mailed  promptly 
at  the  expiration  of  each  month.  Should  the  instructions  not  be  entirely  clear, 
the  board  will  be  glad  to  explain  any  point  should  the  matter  be  brought  to  its 
attention. 

For  guidance  in  making  out  the  monthly  report  of  expenditures  there  follows 
a  sample  report  to  be  used  as  a  model. 

All  correspondence  in  connection  with  these  regulations  or  the  joint  institution 
and  board  funds  to  be  addressed  to  the  executive  secretary  of  the  board,  1800 
Virginia  Avenue  NW.,  Washington,  D.  C. 

T.  A.  Stoeey, 

Executive  Secretary,  United  States  Interdepartmental  Social  Hygiene  Board. 

Adopted  by  the  board  ,  1920. 

[Sample  of  monthly  financial  report  form.] 

United   States   Intekdepaetmentai.   Social   Hygiene   Board. 

Educational  research  and  development  fund,  monthly  report. 

State  Normal  School,  Coe  City,  Fla. : 

Institution $5,  000 

United  States  Interdepartmental  Social  Hygiene  Board 5,000 


Total  joint  fund 10,  000 

Itemized  statement  of  disT)ursements,  month  of  Septem'ber,  1920. 


Date  of 
pay- 
ment, 
1920. 

Name  of  payee. 

Purpose  for  which  paid. 

Budget 
item  No. 

Amount 
paid. 

Sept.    2 
Sept.  16 
Sept.  17 
Sept.  21 
Sept.  30 

Do... 

Do... 

Do... 

Do... 

Do... 

Dr.  John  Fisherman,  director 

Miss    Ruth    Pick,    teacher    of 
hygiene. 

Dr.  Geo.  Bresline,  health  exam- 
iner. 

Mr.  John  Doe,  teacher  of  physical 
training. 

Dr.  John  Fisherman,  director 

Mr.  John  Doe,  teacher  of  physical 
training. 

Miss    Ruth    Pick,    teacher    of 
hygiene. 

Dr.  Geo.  Bresline,  health  exam- 
iner. 

Miss    Frances    Hurley,    stenog- 
rapher. 

Salary  month  of  August,  at  $360  per 

month. 
Salary  period  Sept.  1  to  15,  at  $150  per 

month. 
Salary  period  Sept.  1  to  15,  at  $120  per 

month. 
Salary  period  Sept.  1  to  20,  at  $180  per 

month. 
Salary  month  of  September,  at  $-360 

per  month. 
Salary  period  Sept.  21  to  30,  at  $180  per 

month. 
Salary  period  Sept.  16  to  30,  at  $150 

per  month. 
Salary  period  Sept.  16  to  30,  at  $120 

per  month. 
Salary    for    September,    at    $90    per 

month. 
Salary    for    September,    at    $60    per 

month. 
4  lectures  (Sept.  1,  3,  9,  and  29),  at  $15 

each. 

1 

2 
4 
3 
1 
3 
2 
4 
5 
5 
6 

$360 
75 
60 
120 
360 
60 
75 
60 
90 
60 

Do... 

Dr.   Charles  River,   special  lec- 
turer. 

Total             

60 

1,380 

Sworn  and  subscribed  before  me  this  4th  day  of  October,  1920,  at  Valley  City, 
N.  Dak. 

Robert  A.  Ekskine, 

Secretary-Registrar. 
[l.  s.]     J.  M.  Manning, 

Notary  Puhlic. 


EEPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     239 

Summary. 
[On  reverse  side  of  report.] 


Budget  item  number. 

1 

2 

3 

4 

5 

6 

Balance  brought  forward  from  previous 

3,600 
720 

1,500 
150 

1,800 
180 

1,200 
120 

1,500 
150 

400 

Disbursements  shown  on  this  report 

60 

2,880 

1,350 

1,620 

1,080 

1,350 

340 

2.  APPLICATION  FORM  FOR  ASSISTANCE  IN  THE  ESTABLISH- 
MENT OR  ENLARGEMENT  OF  DEPARTMENTS  OF  HYGIENE  IN 
NORMAL  SCHOOLS,  COLLEGES,  AND  UNIVERSITIES— EDUCA- 
TIONAL RESEARCH  AND  DEVELOPMENT  FUND,  UNITED  STATES 
INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

[Proposed  revision  for  1920-21.] 

A.  Name  and  location  of  institution  selected.    Date  of  application. 

B.  Name,  position,  and  address  of  agents  representing  this  institution  and 
.authorized  to  act  for  it. 

C.  Average  number  of  students  enrolled  : 


All  departments. 

In  preparation  to  teach. 

Men. 

Women. 

Total. 

Men. 

Women. 

Total. 

First  year 

Second  year 

Third  year 

Fourth  year 

t 

Total '. 

1 

i 

1 

D.  Give  present  and  proposed  organization  for  the  establishment  or  enlarge- 
ment of  the  department  of  hygiene  in  this  institution,  in  accordance  with  the 
program  suggested  by  the  Interdepartmental  Social  Hygiene  Board  (pages  — 
and  — ,  Revised  Regulations),  as  follows: 

(I)   Division  of  Infoemational  Hygiene. 

(a)    THE   PRINCIPLES    OF   HYGIENE. 

(1)  General  hygiene. —  (The  agents  that  injure  health,  the  carriers  of  disease, 
the  contributory  causes  of  poor  health,  the  defenses  of  health,  and  the  sources 
of  health.)  Should  be  required  at  least  for  two  periods  a  week.  Most  appro- 
priately given  during  the  first  term  of  the  first  year. 

Indicate  the  curriculum  provisions  available  or  proposed  for  this  course ;  the 
number  of  students  that  will  take  it,  and  the  officer  that  will  teach  it  (the 
director  or  a  special  teacher). 

(2)  Individual  hygiene. —  (Informational  hygiene,  the  care  of  the  body  and  its 
organs,  correction,  and  repair,  preventive  hygiene,  constructive  hygiene.) 
Should  be  required  at  least  for  two  periods  a  week  during  the  second  term  of  the 
first  year. 


240      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

Indicate  the  curriculum  provisions  available  or  proposed  for  this  course ;  the 
number  of  students  that  will  take  it,  and  the  officer  that  will  teach  it. 

(3)  Grou2)  hygiene. —  (Hygiene  of  the  home  and  the  family,  school  hygiene,, 
occupational  hygiene,  institutional  hygiene.)  Required  for  one  term  at  least 
two  periods  a  week  in  the  second  or  third  year. 

Indicate  curriculum  provisions,  etc.,  as  in  (2)  above. 

(4)  Intergrouj)  hygiene. —  (Rural,  community,  municipal.  State,  national,  and 
international  hygiene. )  Required  for  one  term  for  at  least  two  periods  a  week: 
in  the  third  or  fourth  year. 

Indicate  curriculum  provisions,  etc.,  as  in  (2)  above. 

(&)    PEINCIPLES    OF   PHYSICAL   TRAINING. 

(Physiological,  developmental,  and  social  significance  of  gymnastics,  exercise, 
athletics,  recreation,  and  play.)  To  be  required  for  one  term  two  periods  a. 
week  in  the  third  or  fourth  year. 

Indicate  curriculum  provisions,  etc.,  as  in  (2)  above. 

(C)    HEALTH    EXAMINATIONS. 

(1)  Medical  examinations. —  (Making  reasonable  provisions  for  a  private,  per- 
sonal, confidential,  relationship  between  the  examiner  and  the  student.)  To  be 
required  of  all  students  once  each  term.  It  is  recommended  that  satisfactory 
examinations  be  required  of  each  applicant  for  admission  to  the  institution 
before  matriculation  is  permitted. 

State  plans  and  provisions  for  these  examinations  and  give  number  of 
students  covered  each  term  of  year. 

(2)  Sanitary  surveys  and  hygienic  inspections  applied  regularly  to  all  divi- 
sions of  the  institutions,  their  curriculums,  buildings,  dormitories,  equipment,, 
personal  service,  and  surroundings. 

State  plans  and  provisions  for  these  surveys. 

(II)   Division  of  Applied  Hygiene. 

(a)    HEALTH    CONFERENCES. 

State  plans  and  provisions  for  health  conferences. 

(1)  Every   student  advised  under    (c)    above    (health   examinations)    must: 
report  to  his  health  examiner  within  a  reasonable  time,  as  directed,  with  evi- 
dence that  he  has  followed  the  advice  given  or  with  a  satisfactory  explanation 
for  not  having  done  so. 

Give  number  of  conferences  expected  each  term. 

(2)  Must  provide  student  with  opportunities  for  safe,  confidential,  consulta- 
tions with  competent  medical  advisers  concerning  the  intimate  problems  of  sex. 
life,  as  well  as  those  of  hygiene  in  general. 

Give  number  of  consultations  expected  each  term. 

(&)    PHYSICAL   training. 

Six  hours  a  week  (to  be  covered  by  required  courses,  optional  requirements., 
electives,  and  recreational  assignments). 

State  plans  concisely,  giving  proposed  curriculum,  scheduled  requirements., 
optionals,  electives,  assignments,  and  number  of  students  required  to  take  this, 
work. 

(1)  Gymnastic  exercises,  recreation,  games,  athletics,  and  competitive  sports^ 
(intramural  and  intercollegiate). 


KEPOKT  U.  S.  INTERDEPARTMENTAL  SOCIAL.  HYGIENE  BOARD.     241 

(2)  Reconstructional  and  special  training  and  exercise  for  students  not 
qualified  organically  for  the  regular  activities  covered  in  (1)  above.  It  is 
assumed  that  every  student  in  training  physically  able  to  go  to  school  is  entitled 
to  and  should  take  some  form  of  physical  exercise. 

(Ill)  Division   of  Records  and  Planning. 

State  plans  for  making  the  reports  and  for  carrying  on  the  activities  noted 
belovv^. 

(a.)  Investigations,  tests,  evaluating  measurements,  records,  and  reports 
required  each  term  covering  progress  made  under  each  division  and  subdivision 
of  the  department  for  the  purpose  of  discovering  and  developing  more  effective 
educational  methods  of  hygiene. 

(&)  Provide  facilities  for  the  sifting,  selection,  and  investigation  of  problems 
in  hygiene  that  may  be  submitted  to  or  proposed  by  the  department  of  hygiene. 

(c)  Arrange  for  occasional  lectures  on  public  hygiene  and  public  health  from 
competent  members  of  municipal,  State  and  national  departments  of  health, 
and  from  other  appropriate  sources. 

(IV)   Organization  Proposed. 

(1)  Director. — Selected  because  his  scientific  training  and  special  experience 
fit  him  for  supervision,  leadership,  research  and  teaching,  and  for  adminis- 
trative responsibility.    He  will  direct  and  administer  the  department  of  hygiene 

in  the  .     The  curriculum  of  this  department  of  hygiene  shall  include 

"  courses  and  conferences  in  informational  hygiene,  and  courses  and  con- 
ferences and  training  in  the  applications  of  hygiene,  emphasizing  with  appro- 
priate and  due  proportion  and  with  proper  tact  and  persistency  the  serious 
importance  of  the  venereal  diseases,  their  causes,  carriers,  and  prevention,  and 
emphasizing  at  the  same  time  the  other  important  facts  and  applications  of 
general  hygiene,  individual  hygiene,  group  hygiene,  and  intergroup  hygiene." 
(See  Revised  Regulations  Governing  Educational  Research  and  Development 
Fund ,  1921,  pages . ) 

(2)  Teachers  of  hygiene. — Selected  with  special  reference  to  their  wholesome 
influence  on  students  and  because  of  their  ability  to  make  successful  use  of 
their  peculiar  opportunities  to  emphasize  appropriately  and  with  due  propor- 
tion, proper  tact,  and  with  persistency,  the  serious  importance  of  the  venereal 
diseases,  their  causes,  carriers,  injuries,  and  prevention;  and  emphasizing  at 
the  same  time  the  other  important  facts  and  applications  of  general,  individual, 
group,  and  intergroup  hygiene. 

Number  of  women  teachers .    Number  of  men  teachers . 

(3)  Teachers  of  physical  training. — Selected  with  special  reference  to  their 
wholesome  influence  on  students  and  because  of  their  ability  to  make  successful 
use  of  their  peculiar  experiences  to  "stress  with  due  proportion  and  appro- 
priate emphasis  the  venereal  diseases,  their  causes,  carriers,  influences,  and 
prevention." 

Number  of  women  teachers, .     Number  of  men  teachers,  • . 

(4)  Health  examiners.— "Selected,  with  special  care  because  of  the  extra- 
ordinary opporturlfties  presented  in  these  health  examinations  to  exercise  a 
powerful  and  intimate  influence  upon  the  mental,  moral,  and  physical  health 
of  the  students  with  whom  such  examiners  come  in  contact."  Will  make  medi- 
cal examinations,  sanitary  surveys,  and  give  hygienic  instruction  and  counsel 
in  general  and  individual  hygiene;  meet  students  in  health  conferences  and 
consultations ;  and  "  stress  with  due  proportion  and  with  appropriate  emphasis 
the  venereal  diseases,  their  causes,  carriers,  injuries,  and  prevention." 

15610—20 16 


242      KEPORT  V.  S.  INTEEDEPAETMENTAL  SOCIAL  HYGIENE  BOARD. 

Number  of  women  physicians,  .    Number  of  men  physicians, . 

Number  of  other  health  examiners,  . 

(5)  Clerical  and  stenographic  service. — To  cover  the  work  associated  with 
the  several  activities  covered  by  this  department. 

Number,  . 

(6)  Coordinator. —  (This  function  should  be  satisfied  by  one  of  the  personnel 
covered  by  (1),  (2),  (3),  or  (4)  above.)  Will  serve  to  influence  every  teacher 
in  every  department  on  the  entire  staff  of  the  institution  to  meet  his  obligations 
in  relation  to  the  individual  hygiene  of  the  students  in  his  classes  and  to  the 
sanitation  of  the  classrooms  in  which  he  meets  his  students.  The  coordinator 
should  bring  information  to  all  teachers  and  assist  them  to  meet  more  satis- 
factorily their  opportunities  to  help  students  in  their  individual  problems  in 
social  hygiene. 

Give  name,  position  on  staff,  and  concise  statement  of  special  qualifications 
for  this  type  of  work. 

(7)  Special  public  health  lectures. — Special  lectures  on  the  principles  and 
progress  of  public  hygiene  and  public  health.  A  close  coordination  should  be 
secured  between  this  department  and  community  agencies  like  the  department 
of  health,  that  are  concerned  with  public  hygiene. 

Give  very  concise  outline  of  plan  and  sources  from  which  these  lecturers  will 
be  secured. 

(V)  Budget AEY  Fobecast. 

Institution, ,  1920. 

(1)  Total  number  of  students  affected  by  the  courses: 

Men:   First  year,  ;   second  year,  ;   third  year,  ; 

fourth  year,  . 

Women:  First  year, ;  second  year,  ;  third  year, ; 

fourth  year, . 

Total :  Men, ;  women, ;  complete  total,  . 

(2)  Amount  of  resources  furnished  by  institution $ 


Amount  requested  of  Interdepartmental  Social  Hygiene  Board 

Total  joint  resource 

Institution, ,  1920. 

(V) Budgetary  forecast: 

(1)  Total  number  of  students  affected  by  the  courses. 

Men  :  First  year, ;  second  year, ;  third  year, . ; 

fourth  year, 

Women :  First  year, ;  second  year, ;  third  year, 

;  fourth  year, 

Total :  Men, ;  women, ;  complete  total, 

(2)  Amount  of  resources  furnished  by  institution, 

Amount  requested  of  Interdepartmental   Social  Hygiene  Board, 


Total  joint  resource. 


REPORT  U.  S.  INTERDEPARTMENTAL,  SOCIAL  HYGIENE  BOARD. 


243 


(3)  Itemization. 


Present  bud- 
get. 


Proposed 
budeet. 


Number 
payments. 


1.  Director salary. . 

2.  Teachers  of  hydSne: 

(a)  Men  teachers total  salaries. . 

No. @  $ No. @  $ 

(b)  AVomen  teachers total  salaries. . 

No. @  $ No. @  $ 

3.  Teachers  of  physical  training: 

(a)  Men  teachers total  salaries. . 

No. @  $— —  No. @  S 

(b)  Women  teachers total  salaries. . 

No. @  $ No. @  $ 

4.  Health  examiners: 

(a)  Men  physicians total  salaries. . 

No. @  S No. @  $ 

(b)  Women  physicians total  salaries. . 

No. @  S No. @  $ 

(c)  Other  examiners total  salaries. . 

No. @  $ No. @  I 

5.  Clerical  and  stenographic  service total  salaries. . 

No. @  $ No. @  $ 

6.  Special  lecturers total  salaries. . 

Grand  total 


(VI)  Ageeement. 

On  the  basis  of  the  above  presentation,  we,  the  undersigned,  being  duly 

authorized  and  competent  agents  of  the  in  the  city  or 

town  of do  agree  that  a  department  of  hygiene  shall  be  organized  and 

established  in  this  institution  for  the  instruction  and  training  of  all  students, 
men  and  women,  who  enter  this  institution  in  any  of  its  departments  and 
especially  of  those  who  enter  for  the  purpose  of  preparing  themselves  as 
teachers ;  that  this  instruction  and  training  in  hygiene  shall  conform  in  its 
general  plan  and  requirements  with  the  organization  suggested  by  the  United 

States  Interdepartmental  Social  Hygiene  Board  and  described  on  pages of 

its  "  Revised  Regulations  Governing  the  Educational  Research  and  Development 
Fund,"  issued  by  said  board  in  1920 ;  that  every  reasonable  effort  will  be  made 
by  this  institution  to  secure  and  to  maintain  a  fine  quality  and  a  high  standard 
of  instructional  service  in  this  department  of  hygiene ;  that  the  proposed  depart- 
ment shall  become  active  and  be  ready  for  the  instruction  and  training  of  the 

students  at  the  opening  of  the  academic  year  in  the  month  of ;  that 

the  shall  furnish  for  this  purpose  the  sum  of  dollars 

for  conducting  this  department  for  the  academic  year  beginning  in  the  month  of 

,  19 — ,  and  ending  in  the  month  of  ,  19 — ;  and  that  the 

• '■ —  shall  make  every  reasonable  effort  to  maintain  and  fully  expects  ta 

succeed  in  maintaining  this  department  of  hygiene  as  a  permanent  part  of  its 
organization :  Provided,  That  the  United  States  Interdepartmental  Social  Hy- 
giene Board  shall  allot the  sum  of dollars  for  the  purpose 

of  assisting  this  institution  during  the  academic  year  in  conducting  the 

department  of  hygiene,  the  organization  and  establishment  of  which  department 
is  herein  proposed  in  general  conformity  with  the  regulations  governing  the 
educational  research  and  development  fund  of  the  Interdepartmental   Social 

Hygiene  Board ;  and  that  the agrees  that  it  will  submit  a  budget  of 

proposed  expenditures  to  be  paid  from  the  joint  fund  established ;  that  it  will 
transmit   monthly,  beginning  with  the  month  of and  ending  with  the 


244     REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 

month  of ,  a  sworn  statement  of  its  disbursements  therefrom,  in  ac- 
cordance with  instructions  to  be  furnished  and  upon  forms  to  be  provided  by  the 
Interdepartmental  Social  Hygiene  Board ;  and  that  it  will  submit,  on  or  before 
January  30  and  on  or  before  June  30,  a  written  report  to  said  board  covering  all 
the  activities  of  the  department  of  hygiene  during  the  immediately  preceding 

period.    The  further  agrees  that  it  will  furnish  in  duplicate  a 

certified  copy  of  the  official  action  on  the  part  of  this  institution  showing  that  it 
has  a  department  of  hygiene  and  that  it  has  "  set  aside  an  additional  sum  for 
the  same  purpose  at  least  equal  to  the  amount  to  be  received  from  the  United 
States." 


Representing  the 


Representing  the 
Approved : 


Chief  State  Educational  Officer. 
Approved : 


Executive  Secretary, 

U.  8.  Interdepartmental  Social  Hygiene  Board, 

Washington,  D.  C. 


Appendix  G. 

1.  REGULATIONS  GOVERNING  PAYMENTS  TO  STATE  UNIVERSI- 
TIES FOR  THE  ESTABLISHMENT  OF  DIVISIONS  OF  EDUCA- 
TIONAL HYGIENE  IN  STATE  DEPARTMENTS  OF  EDUCATION. 

To    the    United    States   Interdepartmental    Social    Hygiene   Board,    Washing- 

ton,  D.  C. 

Gentlemen  :  In  order  to  assist  the  United  States  Interdepartmental  Social 
Hygiene  Board  in  its  plans  and  program  to  influence  normal  school,  college, 
and  university  officials,  school  superintendents,  school  principals,  school  boards, 
and  school  teachers  to  devise,  establish,  and  carry  out  program  and  activ- 
ities of  hygiene  in  the  elementary,  secondary,  and  higher  educational  institu- 
tions of  the  State  of in  conformity  with  the  general  plan  of  the  UnitecJ 

States  Interdepartmental  Social  Hygiene  Board,  relative  to  instruction  in 
hygiene,  "  emphasizing  with  appropriate  and  due  proportion,  and  proper  tact 
and  persistency,  the  serious  importance  of  the  venereal  diseases,  their  causes, 
carriers,  injuries,  and  prevention,  and  emphasizing  at  the  same  time  the  other 
important  facts  and  applications  of  general  hygiene,  individual  hygiene,  group 

hygiene,  and  intergroup  hygiene,"  I, ,  chancellor  of  the  University 

of  the  State  of  ,  agree  to  assign  to  the  State  superintendent  of  public 

education   of  in   conformity  with,   and  because  of  the  conditions 

stated  in  my  agreement  with  the  State  superintendent  of  public  education,  a 
director  of  educational  hygiene,  and  a  secretary,  and  I  agree  to  pay  the  travel- 
ing expenses  of  the  director,  provided  financial  resources  for  the  purposes  pro- 
posed in  the  program  of  the  United  States  Interdepartmental  Social  Hygiene 
Board,  and  referred  to  above,  are  supplied  by  the  United  States  Interdepart- 
mental Social  Hygiene  Board  as  follows : 

Director  of  Educational  Hygiene,  for  annual  salary,  . 

Secretary  to  the  Director  of  Educational  Hygiene,  for  annual  sal- 
ary,  . 

Appropriation  for  traveling  expenses  of  director, . 

I  agree  further  to  place  before  the  United  States  Interdepartmental  Social 
Hygiene  Board  at  the  end  of  each  academic  term  in  this  State  a  full  report 
covering  the  activities  of  and  under  this  personnel  during  the  preceding  term, 
and  I  will  make  monthly  reports  to  the  United  States  Interdepartmental  Social 
Hygiene  Board  of  all  disbursements  made  from  the  appropriation  paid  to  the 

University  of  the  State  of because  of  this  agreement,  these  reports 

to  be  made  on  forms  supplied  by  the  board. 


Chancellor  of  the  University  of  the  State  of  . 

2.  FORM  LETTER  OF  AGREEMENT  WITH  STATE  UNIVERSITIES  TO 
ASSIGN  ADMINISTRATIVE  PERSONNEL  TO  STATE  DEPART- 
MENTS OF  PUBLIC  EDUCATION. 


To   ,    cJtancellor   of    the    Umversity   of  ,    Address,    

My  Dear  Chancellor :  Acting  on  the  proposals  of  the  University 

of ,  for   Hie  oi'ganization   of  a   division  of  educational   hygiene   in 

the  Stiite   Department   of  Public   Education,   I,   the    imdersigned, 

245 


246      REPORT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD. 
being  the  State  superintendent  of  public  education  of  tlie  State  of 


hereby  make  application  to  the  University  of  for  the  assignment 

of  a  director  of  educational  hygiene,  qualified  to  carry  out  under  my  directions 
the  purposes  outlined  in  this  agreement,  this  director  to  be  acceptable  to  me, 
his  salary  and  traveling  expenses  to  be  paid  and  his  secretarial  help  to  be 

supplied   by   the   University   of   .     With   this    assistance    from    the 

University  of  ,  I,  as  the  authorized  State  superintendent  of  public 

education  of  the  State  of  ,  agree  to  establish  in  the  State  depart- 
ment of  public  education  of a  division  of  educational  hygiene  under 

the  following  conditions: 

1.  Organisation. — The  division  of  educational  hygiene  shall  include  all  the 
activities  and  personnel  in  the  State  department  of  piablic  education  that  have 
to  do  with  health  teaching,  physical  education,  and  health  care  of  pupils  (and 
students)   in  the  schools  of  the  State. 

2.  Purposes. — The  division  of  educational  hygiene  "  shall  be  concerned  with 
the  development  and  permanent  maintenance  of  departments  of  hygiene  or 
courses  in  the  principles  and  practices  of  hygiene  in  all  the  educational  insti- 
tutions of  this  State,  public,  institutional,  and  private ;  elementary,  secondary, 
normal,  collegiate,  university,  and  professional." 

(a)  The  division  of  educational  hygiene  will  make  every  reasonable  effort 
to  encourage  and  develop  in  the  schools  of  the  State  effective  teaching  of 
hygiene,  which  shall  include  "  courses  and  conferences  in  informational  hygiene, 
and  courses,  conferences,  and  training  in  the  application  of  hygiene,  emphasizing 
with  appropriate  and  due  proportion  and  with  proper  tact  and  persistency 
the  serious  importance  of  the  venereal  diseases,  their  causes,  carriers,  and 
prevention,  and  emphasizing  at  the  same  time  the  other  important  facts  and 
applications  of  general  hygiene,  individual  hygiene,  group  hygiene,  and  inter- 
group  hygiene  "  in  general  conformity  with  the  program  of  the  United  States 
Interdepartmental  Social  Hygiene  Board." 

( 6 )  The  division  of  educational  hygiene  will  "  within  the  limits  of  the  author- 
ity and  educational  influence  of  the  State  department  of  which  it  is  a  part, 
in  every  reasonable  way,  assist  all  normal  schools,  colleges,  and  universities 
and  similar  institutions  in  the  State  to  instruct  all  their  students,  and  particu- 
larly those  students  that  are  preparing  to  teach,  concerning  the  principles  and 
practices  of  hygiene  in  general  conformity  with  the  program  proposed  by  the 
United  States  Interdepartmental  Social  Hygiene  Board." 

(c)  The  division  of  educational  hygiene  shall  make  every  reasonable  effort 
to  effectively  influence  "  selected  schools  to  train  teachers  of  hygiene  in  all  of 
its  subdivisions,"  and  it  "  shall  influence  elementary  and  secondary  schools  to 
organize  and  carry  on  courses  and  classes  for  all  children  whereby  they  may  be 
safely,  wisely,  and  properly  instructed  in  the  principles  and  practices  of  hygiene 
that  are  fitting  and  appropriate  to  the  age  period,  the  maturity  and  the  develop- 
ment of  the  child  concerned." 

{d)  The  division  of  educational  hygiene  will  make  every  reasonable  effort  to 
bring  about  an  educational  condition  whereby  every  teacher  will  be  as  well 
educated  and  informed  in  hygiene  as  he  is  in  English  or  arithmetic. 

3.  Administration. — Under  the  general  administrative  direction  of  the  State 
superintendent  of  public  education  this  division  of  educational  hygiene  shall  be 
conducted  by  a  director  of  educational  hygiene. 

(a)  Qualifications:  The  director  of  educational  hygiene  shall  have  the  fol- 
lowing qualifications  or  their  satisfactory  equivalent:  A  college  education;  a 
medical  education  with  degree  or  equivalent  postgraduate  study  in  hygiene; 
satisfactory  teaching  and  administrative  experience  in  a  well-organized  educa- 


REPOKT  U.  S.  INTERDEPARTMENTAL  SOCIAL  HYGIENE  BOARD.     247 

tional  system ;  some  experience  in  municipal,  county,  State,  or  National  health 
service  (not  a  fixed  requirement). 

(b)  Duties:  The  duties  and  functions  of  the  director  of  this  division  of  edu- 
cational hygiene  shall  be  to  supervise  and  direct  the  division  of  educational 
hygiene  and  to  focus  the  powerful  influence  of  the  State  department  of  public 
education  upon  every  educational  institution  in  the  State  for  the  purpose  of 
bringing  each  institution  to  meet  its  obligations  to  train  and  prepare  pupils 
and  students  and  to  educate  teachers  in  the  important  and  practical  facts  of  in- 
formational and  applied  hygiene  in  general  conformity  with  this  agreement. 
4.  Reports. — It  is  agreed  that  semiannual  reports,  January  and  July,  will 

be  made  to  the  University  of  the  State  of ,  covering  all  the  activities 

of  this  division  of  educational  hygiene  so  long  as  the  division  receives  help  from 
the  State  university,  and  that  I  will  receive  such  advice,  help,  and  counsel  as  the 
:tate  university  may  offer,  and  make  such  use  of  said  communications  as  my 
judgment  dictates. 


State  Superintendent  of  Public  Education. 


Approved : 
(1) 

(2) 


Chancellor,  University  of  the  State  of 


Executive   Secretary,    United    States   Interdepartmental    Social 
Hygiene  Board. 

(3)  By  the  executive  committee  under  date  of . 

(4)  By  the  United  States  Interdepartmental  Social  Hygiene  Board  under 

date  of -, 


Appendix  H. 
PUBLICATIONS  ON  HAND  JUNE  30,  1920. 

1.  General  and  Miscellaneous. 

The  Work  of  the  United  States  Interdepartmental  Social  Hygiene  Board,  by 
T.  A.  Storey,  M.  D.    October,  1919. 

Venereal  Disease  Control  in  the  Army,  by  William  F.  Snow,  M.  D.,  and  Wilbur 
A.  Sawyer,  M.  D.    April  10,  1918. 

"Why  Let  it  Burn?"     (American  Social  Hygiene  Association  pamphlet)  1919. 

Alias  Hygiene,  by  T.  A.  Storey,  M.  D.    March,  1920. 

Factors  Making  for  a  Low  Venereal  Record  in  the  American  Expeditionary 
Forces,  by  P.  M.  Ashburn,  M.  D.    December  13,  1919. 

Senate  Document  No.  230,  Sixty-sixth  Congress,  second  session.  Statement 
showing  activities  and  disbursements  of  board  pertaining  to  public  health  for 
fiscal  year,  1919.    February  18,  1920. 

Hearings  on  the  Sundry  Civil  Bill  before  the  Committee  on  Appropriations, 
United  States  House  of  Representatives,  Sixty-sixth  Congress,  second  session, 
February,  1920. 

War  Department,  General  Orders,  No.  135,  1919.     (1920.) 

2.  Peotective  Social  and  Medical  Measures. 

Program  of  Protective  Social  Measures.    February.  1920. 

Functions  of  Protective  Social  Measures  Staff.    April  1,  1920. 

Memorandum  on  Distinguishing  Between  Crime  and  Disease.     March  22,  1920. 

Publication  of  the  United  States  Navy  Department,  "  Morale."    April,  1920. 

Social  Hygiene  and  the  War  Work  with  Women  and  Girls,  by  Jane  Deeter 
Rippin.    January,  1919. 

Regulations  Governing  Allotments  of  Funds  for  Venereal  Disease  Prevention 
Work.    September  13,  1918. 

Rules  and  Regulations  Governing  Expenditures  from  the  State  Allotments  of 
Chamberlain-Kahn  Funds,  for  the  fiscal  year  1920.     June,  1919. 

Rules  and  Regulations  Governing  Expenditures  from  the  State  Allotments  of 
Chamberlain-Kahn  Fund,  for  the  fiscal  year  1921.    June,  1920. 

Statistical  Study  of  Case  Records  of  15,000  Women  and  Girls,  (In  prepara- 
tion. ) 

3.  Educational  Research  and  Development. 

Regulations  Governing  the  Educational  Research  and  Development  Fund. 
January,  1919. 

Universal  Physical  Education — A  State  and  National  Obligation,  by  Thomas 
A.  Storey,  M.  D.    December  18,  1918. 

National  Collegiate  Athletic  Association — Report  of  the  Committee  on  Ex- 
tending the  Influence  of  the  Association.    December  30,  1919. 

The  Reconstruction  Program  for  Physical  Education  in  the  Colleges,  by  Dean 
J.  R.  Angell.    December  27,  1918. 
248 


KEPOET  U.  S.  INTERDEPAETMENTAL,  SOCIAL  HYGIENE  BOARD.     249 

War  Emphases  on  Physical  Training,  by  Thomas  A.  Storey,  M.  D.    1919. 

War-Time  Revelations  in  Physical  Education,  by  Thomas  A.  Storey,  M.  D. 
February,  1920. 

A  General  Outline  and  Syllabus  on  Hygiene.     Revised  edition,  1920. 

Physical  Training  and  Athletics.  Resolutions  adopted  by  the  National  Col- 
legiate Athletic  Association. 

4.  Scientific  Researches. 

Experimental  Medicine  and  the  Venereal  Diseases,  by  William  F.  Snow,  M.  D.. 
and  Thomas  A.  Storey,  M.  D.    1920. 

Regulations  Governing  the  Scientific  Research  Fund.    January,  1919. 

Scientific  Researches — Outline  of  Work  in  Progress  January  1,  1920.    1920. 

Scientific  Researches — Second  Announcement.    April,  1920. 

A  New  Germicide  for  Use  in  the  Genito-Urinary  Tract :  "  Mercurochrome- 
220."  Preliminary  report,  by  Hugh  H.  Young,  M.  D.,  Edwin  C.  White,  Ph.  D., 
and  Ernest  O.  Swartz,  M.  D.    November  15,  1919. 

A  Simplified  Plate  Method  of  Partial  Oxygen  Tension  in  the  Cultivation  of 
the  Gonococcus.    June  19,  1920. 

A  Series  of  Studies  for  the  Recognition  and  Diagnosis  of  Treponema  Pallidum 
in  Venereal  Diseases  and  the  Effect  of  Various  Drugs  and  Materials  as  Germi- 
cidal Agents  against  Treponema  Pallidum  researches  conducted  by  Dr.  Randle 
C.  Rosenberger  and  Dr.  John  I.  Fanz.     October,  1919. 

A  More  Rapid  and  Improved  Method  of  Demonstrating  Spirochetes  in  Tissues, 
by  Alfred  S.  Warthin,  M.  D.,  and  Allen  C.  Starry.    January,  1920. 

Axi  Improved  Method  for  the  Preparation  of  Primary  Arsanilic  Acid,  by  Har- 
rold  C.  Oheetham  and  John  H.  Schmidt.    April.  1920. 


INDEX. 


Page. 

Act  making  appropriations  (Appendix  A) 199 

Activities 171 

Acriflavine  in  gonorrlaea 128 

Adams,  Dr.  Roger 126 

Additon,  Miss  Henrietta 171 

Administrative  fund 28,29 

Agents : 

Acting  as  law  enforcement  officers 44 

Confidential  protective  social,  duties  of 183 

Field  service 204 

of  board,  local  assistanre  by 16, 89 

of  board,  location  of 20, 179 

of  board,  reports  by 95 

Protective  Social 44, 48 

Aid  to  States 17,  21,  28,  31,  98, 156,  162,  168,  171,  174 

Akron  Welfare  Home  for  Women 99, 157, 175 

Alabama 48,  49,  50,  97, 157,  174,  179,  190,  218 

University  of 158 

State  Training  School  for  Girls 175 

Albert,  Dr.  Henry 114 

Alderson,  Dr.  H.  E 116 

Allentown,  Pa 176 

Alexandria,  La 177 

Allotments  (see  also  Funds)  : 

Numbers,  amounts,  purpose,  distribution,  and  relevant  facts 133 

Percentage,   population 218 

To  States,  institutions,  and  organizations 168 

To  States,  1921,  appropriations 217 

Albany,  Ga 98 

Amendments : 

Proposed,  and  their  fate 169 

To  law 199 

American  Association  of  Genito-Urinary  Surgeons 153 

American  Journal  of  Public  Health,  extract  from 194 

American  Journal  of  Syphilis 116 

American  Lake,  Wash 176 

American   Psychopathological   Association 153 

American  Social  Hygiene  Asssociation 136, 137, 153, 161 

Estimates  of  venereal  disease : —        11 

Report  by  general  director  of 154 

Fourteen  researches 158 

Anna  Finstrom  Detention  Hospital,  Columbia,  S.  C 99, 157 

Appendices 193fC 

Applications  and  allotments,  tabular  summary  on  June  30 132 

251 


252  INDEX. 

Application  forms :  Page. 

For  educational  research  and  development 239 

For  scientific  x'esearcli 230 

Applications  for  assistance  from  the  educational  research  and  develop- 
ment fund,  number,  purpose,  and  disposition 131 

Appropriation.     (See  also  Fund)  : 

Aid  to  States  in  protection  of  military  and  naval  forces 156, 157 

Bill,  Army,  Chap.  XV.,  July  9,  1918 43,  44 

Congressional 162 

For  allotment  to  States  for  the  prevention,  treatment  and  control  of 

venereal  diseases.     {See  Payment  to  States  fund) 17, 19,  20,  23 

For  the  care  of  civilian  persons.     (See  Aid  to  States  fund.)  . 

For  the  purpose  of  discovering  more  effective  medical  measures  in  the 

prevention  of  venereal  disease.     {See  Scientific  research  fund) 18 

Interdepartmental  Social  Hygiene  Board 156 

Payment  to   States  for  the  prevention,   treatment,   and   control  of 

venereal   diseases 156, 218 

Payments  to  universities,  etc.,  for  research  in  educational  measures, 

1920 156 

Payments   to   universities,   etc.,   for   research   in   venereal   diseases, 

1920 156 

Ruling  of  Comptroller  of  Treasury  regarding 168 

Arkansas 48,  50,  97, 157, 174, 179, 190, 195,  218 

Arizona 10,  48,  49,  50,  97, 157, 179, 190,  218 

Army 11, 12, 17,  24,  85,  93,  95, 161, 164 

Appropriation   act 169.  217 

Cost  of  venereal  disease  in 193 

Medical  service 160 

Officers  179 

Protection  from  venereal  disease 43 

Sources  of  infection 45 

Stations 49 

Strength   of 194 

Venereal  infections  in 1 162, 164 

Illustration  follovping  page 85 

Arsanilic  acid 119, 128 

Arsenic,  the  Gutzeit  method 119' 

Arnstein,  Miss  Natalie 111 

Arsphenamine 117, 118,  216,  217 

Distribution  of  by  State  boards  of  health lOa 

Ashburn,  CoL  P.  M 2 

Studies  on  venereal  diseases  in  the  Army 12 

Assignation  houses 1& 

Assistant  Secretary  of  the  Treasury 166 

Athens,  Ga  96 

Atlanta,  Ga 176 

Augusta,  Ga  176, 179 

Baker,  Newton  D.,  Secretary  of  War 166 

Baldwin,  Dr.  W.  M 121 

Baltimore,  Md 96-99, 176-179 

State  Department  of  Health  Hospital 99-157 

Bangor,  Me 98 

Barnes  Hospital,  St.  Louis,  Mo 120 


INDEX.  253 

Page. 

Bartlett,  Dr.  Bernice 125 

Bath,  Me 98 

Battle   Creek,  Mich 176-179 

Beaumont,   Tex 98 

Bellingham,  Wash.,  State  Normal  School 159 

Bergehu,  Frank  H 126 

Bethlehem,  Pa 96 

Biloxi,    Miss 98 

Birmingham,    Ala i 99, 175-177 

State  Training  School  for  Girls 99-157 

Boards  of  Health.     (See  Departments  of  Health.) 

Boston,    Mass 179 

Boy  Scouts __; 151 

Bradley,  Dr.  H.  C 1 119 

Brady  Laboratory  of  Pathology  and  Bacteriology , 113 

Brady  Urological  Institute 107, 108, 109, 118 

Bremerton,  Wash 177 

Brooklyn,  N.  Y , 176 

Brooklyn  Rapid  Transit  Co 153 

Brown,  Dr.  G.  O 111 

Brownwood,  Tex 98 

Buckell,  George  T 112 

Bureau  of  Education,  United  States 137 

Business  office : 

Chart  of 36 

Report   on 155 

Cairo,  111 98 

California 48,  51,  97, 157, 179, 190,  218 

State  Normal  School,  San  Diego 158 

University  of  California,  Berkeley 115,129,159 

Cambridge,  Md 158 

Cambridge,  Mass 177 

Camp  Fire  Girls 151 

Camp   Holabird 153 

Canal  Zone 77 

Carlisle,  Pa 96 

Carolyn  House,  Spartanburg,  S.  C 175 

Carson  City,  Nev 98 

Case  histories 85ff 

Case    records 204 

Case  work : 

Individual,  in  social  hygiene 177 

With  women  and  girls 78 

Table   1.  Number  of  cases 78 

Table  2.  Color  of  new  cases 78 

Table   3.  Men  involved  in  new  cases 78 

Table   4.  Sex  relations  of  new  cases 78 

Table   5.  Source  of  complaint  of  new  cases 78,  79 

Table   6.  Reason  for  complaint  of  new  cases 78, 80 

Table   7.  Disposition  of  new  cases 78,  81 

Table   8.  Disposition  of  continued  and  reopened  cases 78,  82 

Table   9.  Record  of  total  dispositions 78,83 

Table  10.  Special  data 78,84 


254  INDEX. 

Chace,  Archibald  E.,  M.  D.,  chief  surgeon,  St.  Louis  Southwestern  Rail-    Page. 

way  Lines 195 

Chamberlain,  Col.  Weston  P 2,193 

Chamberlain-Kahn  Act.     {See  Fund,  payments  to  States) 214 

Chancroid  as  a  factor  in  war  (see  also  venereal  diseases) 92, 160, 161, 195, 196 

Chancroids : 

Organic  dyes  in  the  treatment  of 107 

Study  of  the  etiology  of 108 

Chancroids  and  others : 

Cases  of,  reported  to  State  boards  of  health  in  1919 . 102 

Cases  of,  reported  to  State  boards  of  health  in  1920 102 

Chapter  XV  of  the  act  making  appropriations 199 

Charts : 

Charts  of  appropriations,  functions,  and  personnel,  compiled  in  satisfac- 
tion of  congressional  action .. 28ff 

Administrative  fund,  purposes  and  personnel 29 

Aid  to  States  fund,  purposes  and  personnel 31 

Business  office 37 

Division  of  Educational  Research  and  Development 41 

Division  of  Records,  Information,  and  Planning A 38 

Division  of  Relations  with  States  (protective  medical  measures) 39 

Division  of  Relations  with  States  (protective  social  measures) 40 

Division  of  Scientific  Research 42 

Educational  research  and  development  fund,  purposes  and  personnel 32 

Executive  office 35 

Funds  and  their  purposes 28 

General  organization ^ 34 

Payment  to  States  fund,  purposes  and  personnel 30 

Personnel  section 36 

Scientific  research' fund,  purposes  and  personnel 33 

Chattanooga,  Tenn 175, 176 

Chattanooga  detention  house  and  hospital 175 

Chattanooga  venereal  quarantine  hospital 99, 157 

Cheetham,  Harold  C 119, 126, 128 

Cheney  Normal  School,  Wash 159 

Chester,  Pa 177 

Chicago,  111 176, 179 

Chief  health  officer,  support  of 48 

Chillicothe,   Ohio 176 

Christiansen,  W.  G 121 

Cincinnati,  Ohio 177 

Cincinnati  General  Hospital 99 

University   of . 159 

Cities  in  which  agents  were  stationed ^ 176, 179 

Civil  Service  Commission 36 

Civilian  quarantine  and  isolation  fund  (see  Fund,  aid  to  States) 174,216 

Clark,  Dr.  P.  E 119 

Cleveland,  Ohio 177 

Clinic,  Massachusetts  State  Psychiatric  Institute 125 

Clinical  examination;  value  of,  Cornell  students 149 

Clinics 102, 103 

Establishment  of 102 

Efficiency  of  treatment  of  gonorrhea 104 


INDEX.  255 

Clinics — Continued.  Page. 

Efficiency  of  treatment  of  syphilis 104 

For  treatment  of  venereal  disease 216 

Per  capita  cost  of  treatment  in 104 

Venereal  disease 23,  44,  81,  82,  S3, 106 

Coe,  H.  C 116 

Colleges.     ( See  Educational  research  and  development ;  Scientific  research. ) 

Colorado 48,  97, 157, 179, 190,  218 

State  Teachers'  College,  Greeley 141, 158 

Columbia,  Pa 96 

Columbia  University 108, 129, 137, 152, 158 

College  of  Physicians 1.59 

Special  courses  for  graduates 103 

Columbus,    Ga 96 

Columbus,  N.  Mex 96 

Commission  on  Training  Camp  Activities 99, 163, 164, 170, 175, 179, 183 

Law  Enforcement  Division — section  on  women  and  girls   (see  also 

Section) 176 

Community    organization 47 

Comptroller  of  Treasury,  ruling  of 168 

Congress .^ 161 

Conklin,  Luther 112 

Connecticut 48,  52,  97, 129,,  157, 179, 190,  218 

Cook,  Dr.  Marjorie  W 115 

Cornell  University,  Ithaca,  N.  Y 129, 141, 145, 158, 185 

Report 147 

Report  on  application  of  educational  program,  quotation  from 149 

Medical  college 112 

Corpus  Christi,  Tex . 98 

Cost  of  venereal  disease  (see  also  venereal  diseases) 193fE 

Cumberland,  Md 98 

Dance  halls 16 

Daniels,  Josephus,  Secretary  of  the  Navy 2, 166 

Davis,  Dr.  D.  M 118 

Davis,  Dr.  Edwin  G 110, 128 

Dayton,   Ohio 177 

Delaware 48,  52,  97, 157, 179, 190,  218 

Delinquency,  cases  of 177 

National  study  of 178 

Prevention  of 91 

Delinquent  women  and  girls  (see  also  Prostitute) 163,178 

Care  of 173, 174 

Case  histories  of 85fE 

Case  work  with 78ff 

School  for _*1 91 

Statistical  study  of  15,000  cases  of 12, 14 

Delinquents,  care  of 178 

Denver,    Colo 96, 179 

Departments  of  health,  State.     (See  also  Fund,  payments  to  States) 190 

Allotments  to 16, 17, 20 

Cases  of  veneral  disease  reported  to 11,23 

Departments  of  Hygiene 137 

(See  also  Hygiene.) 

Allotments  to  educational  institutions  of 135 


256  INDEX. 

Departments  of  Hygiene — Continued.  Page. 

Establishing  of - 131 

In  colleges,  etc 15, 19,  24, 132, 133, 134 

Support  of 135 

Establishing  of,  in  colleges,  etc.  (see  also  Educational  research) 130, 186 

Des  Moines,  Iowa 85,  98, 176 

Detention  hospitals 177fe 

Detention  houses 177ff 

Assistance  of 17, 19,  22,  98, 99, 171, 172 

Need  of,  in  camp  towns 172 

Detroit,  Mich 177, 179 

Diphenoxychlorasine ; 126 

District  of  Columbia 48,  52, 97, 157, 179, 190, 198, 199,  218 

Dibromfluorescein 109 

Divisions  of  Educational  Hygiene,  cooperation  of  State  universities  with 

State  departments  of  education  in  establishing 131 

Divisions,  of  the  board  (see  Charts) 27 

Educational  Research  and  Development 129 

Report  on 129 

Records,  Information  and  Planning 37,204 

Relations  with  States 39,40,43 

Scientific  Research 42 

Report  of 107 

Division  of: 

Venereal  Diseases  in  State  Departments  of  Health 17,  20, 100 

Venereal  Diseases  in  the  Bureau  of  the  Public  Health  Service 198 

Venereal  Diseases,  United  States  Public  Health  Service.  {See  also 
Public  Health  Service,  United  States,  Division  of  Venereal  Dis- 
eases. ) 

Dodge,  Kansas 98 

Dorcas   Home 175 

Drug  law,  violation  of  the  State 88 

Drugs : 

Antisyphilitic  117 

Use   of 88,89 

Duties  and  powers  of  the  United  States  Interdepartmental  Social  Hygiene 

Board 197,  217 

East  St.  Louis,  111 176 

Easton,  Pa 96 

Eberson,  Dr.  F 23, 124 

Education,  physical 166 

Regarding  venereal  diseases 165 

Educational  measures 232, 233 

Developing  more  elTective 149, 150 

Educational  research  in  the  development  of  motion-picture  films  and  new 

literature 154 

Educational  research  and  development ^ 165 

Division  of 129 

Plans  of 130 

Educational  research  and  development  fund 15, 

16, 19,  20,  27,  31, 129, 131, 133, 136, 153, 156, 158, 163, 186,  232,  241,  245 

Administration  of 139 

Appropriations  from 19,24 

Expenditures  from 189 

Revised  regulations  governing 243 


INDEX.  257 

Page. 

Educational  work  of  erliicational  section,  Public  Health  Service 106 

Egerer,  Dr.  Grote 122 

El  Paso,  Tex 176 

England,  cost  of  venereal  disease  in 193, 196 

Englewood,  N.  J 176 

Engman,  Dr.  M.  F 124 

Rosin 109 

Briclvson,  Dr.  Mary 114 

Erie,    Pa 177 

Evanston,  111.,  Northwestern  University 159 

Exaniinei'S,    health _ 241 

Executive    committee 2, 166 

Executive  office 34 

Executive  secretary 167, 171 

Expenditures : 

From   appropriations 8,9,156,157 

Report    of 238 

Extensions  of  duties  and  powers  from  appropriations  for  the  fiscal  year 

ending  June  30,  1921 199 

Fairmount  Hospital 175 

Falconer,  Mrs.  Martha  P 171 

Fanz,  Dr.  John  I 118-119,128 

Ferguson,   Hazel 123 

Frankel,    Dr , 115 

Field  agents.     {See  Agents.) 

Field   Service - —  163, 170, 176,  203,  204 

Educational 139 

[See  "  Interdepartmental  Social  Hygiene  Board  "  ;  "  Agents.") 

Field  staff 178-179 

Having  headquarters  in  State  with  civil-service  classification  of  each_     49ff 

Fifty-fifty  plan 236 

Film,  for  use  with  policemen^ 136 

Describing  the  protective  social   measures  program   of  the  United 

States  Interdepartmental  Social  Hygiene  Board 136 

^  "  Fit  to  win  " 152-153 

Informational  and  educative  effects  of _ 153 

Preliminary  study  of —  152-154 

A  preliminary  study  of  all 151-152 

Financial  summary 156fe 

Fisk  University,  Nashville,  Tenn 135-159 

Florence  Crittenden  League,  New  York,  N.  Y 99-157 

Florence,  S.  C 98 

Florida 48,  52,  97,  157,  174,  179,  190,  218 

Form : 

Application  for  assistance  in  scientific  research 230 

Application   for    assistance,   educational   research    and   development 

fund__-l 239 

Financial  report,  educational 238 

Request  for  maintenance  of  venereally  infected  persons 201-202 

Fort  Worth,  Tex '      177 

Franiingham,    Mass 172 

1.^610—20 17 


258  INDEX. 

Page. 
Franz,  Dr.  S.  I 152 

Functions  of  protective  social  measures  staff 203 

Funds,  details  of  appropriations  from 156,  157,  158,  159 

Payment  to  States  fund;  Aid  to  States  fund   (see  Educational  re- 
search  and   development   fund ;    Administrative   fund ;    Scientific 
research  fund.) 
Funds  that  are  allotted  by  the  Congress  through  the  United  States  Inter- 
departmental Social  Hygiene  Board 216 

Fund : 

Administrative 28, 29 

Aid  to  States 17,  21,  28,  31,  98,  156,  162,  168,  171, 174 

Educational  research  and  development  fund 15,  16, 19,  20,  27,  31,  32, 129, 

131,  133,  136,  156,  158,  163,  186,  232,  241,  245 

Payment  to  States  fund 19,  23,  28,  30,  101,  105,  156, 162,  174,  190 

Scientific  research  fund 16,  23,  28,  33,  136,  156,  183,  185,  229 

Gaebe,  Dr.  R 124 

Gainesville,  Fla. :  University  of  Florida . 158 

Gainesville,  Tex 175 

Girls'  Training  School 99-157-175 

Gallup,  N.  Mex 98 

Galveston,  Tex 98 

Gay,  Dr.  Frederick  P : 115 

General  Electric  Co.,  Schenectady,  N.  Y 122 

Georgia 48, 49,  50„97, 157-179-190-218 

Glass,  Carter 2 

Goldsboro,  N.  C 98 

Gonococcus : 

Isolation  and  cultivation  of 114 

■    Studies  in  the  bacteriology  of 111 

Study  for  the  isolation  and  identification  of 113 

Gonococcus  group :  A  serological  study  of 112 

Gonorrhea 92-104-108-160-161-195-196 

As  a  factor  in  vpar 160 

Cases  of,  reported  to  State  boards  of  health 102 

Certain  anilin  dyes  in  the  treatment  of 110 

Development  of  new  synthetic  drugs  in  treatment  of 115 

Fixation  reaction  in 115 

Investigation  of  acriflavine  in  the  treatment  of 110-111 

Investigation  into  treatment  in  acute  and  chronic 108 

■  Serologic  tests  for 114 

Subacute  and  chronic 115 

Plans  for  the  control  of 161 

(See  also  Venereal  diseases.) 

Gonorrheal  infection  in  the  male 114 

Graham,  Dr.  George  S 122,123 

Great  War 14 

Greenville,  S.  C _' 177 

Grigg,  Walter  K 123 

Group   hygiene - 233-234 

Hagerstown,  Md ■ 98 

Hale,  R.  W.,  jr , 108-109 

Hall,  J.  L 126 

Hamilton,   C.   S , 126 


INDEX.  259 

Page. 

Hampton  Normal  and  Agricultural  Institute,  Hampton,  Va 135, 159 

Harris,  Dr.  Mary  B 171 

Harrisburg,    Pa , , 85-98 

Hart,  Merrill  0 112 

Harvard,    program . 149-151 

Report,  quotation  from 151 

Medical   School,  Boston,  Mass__ 121-159 

University,   Cambridge,  Mass 129-141-158-185 

Hattiesburg,  Miss ,__, 176 

Hawaii , 77 

Hazleton,    Pa , , 96 

Health  conferences,  individual,  at  Hai'vard,  at  Cornell,  as  instrument  of 

instruction 149 

Health  conferences  and  consultations 144-23'^240 

Health,  departments  of 234 

In  colleges,  etc.   (see  also  Departments  of  hygiene) 235 

Examinations 143,  240 

Instruction , 189 

General  problem  of  Industries  and  communities 151 

Health  officer,  responsibilities 48 

Hearings  of  June  18,  1918,  record  of 167 

Hektoen,  Dr.  L 114 

Hempstead,  Long  Island 176 

Herrold,  Dr.  Russell 114, 128 

Herrold,  Ursula,  S 114 

Herschler,  Dr.  Rose 123 

Highlands,  N.  J 177 

Hirschfeld,  Dr.  M.  H 125 

Hirschfelder,  Dr.  A.  D 112 

Hoffman,  Dr.  R.  V 171 

Hospitals,  assistance  to 20,  22,  98,  99, 171, 172, 177 

Venereal  disease 81, 82,  83 

Houston,  David  F 2 

Houston,  Tex 175-177 

Hunt,  Dr.  Reid ^ 121 

Hygiene : 

Applications  of,  courses  and  conferences  in 165, 188,  233 

Division  of  applied  hygiene 234-240 

Defensive  hygiene  of  venereal  diseases 162 

Departments  of 131, 134, 137, 141, 142, 151, 165, 166 

Departments  of,  application  form  for  the  establishment  or  enlarge- 
ment of 239 

Departments  of,  director 241 

Organization  proposed 241 

Progress  in  organization  of 131-140 

Establishment  or  enlargement  of 237-239 

In  colleges,  etc 15,  24, 130, 132, 133, 134, 234 

Instruction  and  training  in 147 

Division   of- 246,  247 

Educational  methods  in 234 

Educational,  of  venereal  diseases 14, 15 

Establishment  of  departments  of  hygiene 233 

Hygiene  factors 233 


260  INDEX. 

Hygiene — Continued.  Page. 

General . 165,  233,  234,  239,  241 

Government    investments 15 

Governmental  obligations 12 

Group   liygiene 165, 166,  240,  241,  245,  246 

In  board's  program  of  instruction 142-189 

Individual  hygiene 239,  241,  245,  246 

Separation  of  sexes;  in  courses 150,165,166 

Influence,  departments  of  hygiene 1.50 

Information  of  venereal  diseases 14 

Informational,  courses  in,  Cornell,  Harvard 149, 150, 154, 122,  239 

Informational,  courses  and  conferences  in 165 

Inspections 233 

Instruction 15-19 

Instruction  and  training : 141,142,143 

Intergroup    165, 166,  240,  241,  245,  246 

Hygiene  of  venereal  diseases  (see  also  Venereal  diseases;  also  Edu- 
cational research   and  development) 23-24 

Opportiuiities  in  informational  courses 149 

Prevention 15-16 

Principles  of 143,  233,  239 

Problems    in 234 

Program    of 137, 147, 1.51,  235 

Adoption  by  preparatory  schools 151 

Protective 14,16 

Public —      235 

Reconstruction 15, 17 

Remedial,  support  of,  in  States 15, 16, 17 

Scientific  research  for  informational 16 

Sex - 165 

Social,  instruction  in  summer  schools 131 

Summary  of  factors 148 

Syllabus  and  outline  on —  136, 148 

Teachers    of 241 

Teaching  of  informational 138, 147 

Idaho 48,  54, 157, 190,  218 

Illinois 48,  97, 157, 179, 190,  218 

University   of —  126, 129, 159 

Indiana - 55,  56,  97, 157, 179, 128 

University  of,  Bloomington,  111 158 

Indianaiwlis,  Teachei's'  College  of 158 

Individual  hygiene 233,  238 

Industrial  School  for  Colored  Girls,  Columbia,  S.  C 175 

Infections.     (See  Venereal  disease.) 

Information  courses,  opportunities  in 149 

Insane,  Government  Hospital  for  the 152 

Institutions  for  delinquent  women  and  girls 177 

Instructions  for  reporting  expenditures  from  allotments 237 

Interdepartmental  Social  Hygiene  Board : 

Accomplishments 21 

Act  under  which  board  operates 197 

Activities 171 

Charts    of -. 28ff 

Duties— 167 


INDEX.  261 

Interdepartmental  Social  Hygiene  Board — Continued.  Page. 

Establishment  of 161 

Field  Service 18,20,21,22 

Menil)ers 102 

Organization 38,  28fl: 

Personnel  assigned  from  another  Gov't  dep't  in  central  office 21 

Through  Civil  Service ' 20 

Policy  with  cooperating  educational  institutions 138 

Program 15 

Intergroup  hj^giene 233, 234 

Iowa 48,  97, 157, 179, 190, 218 

State  College  of  Agriculture  and  Mechanic  Arts,  Ames 158 

State  University  of  Iowa,  Iowa  City . 158 

University  of  Iowa,  College  of  Medicine 114 

Jacks,   Dr.   William 108 

Jackson,  Miss 98 

Jacksonville,  Fla 98 

Jacobs,  Dr.  F.  M : 124 

Jeans,  Dr.  P.  C ; 120 

Jefferson  County  Institutions,  Louisville,  Ky 99, 175 

Jefferson  Medical  College,  Philadelphia,  Pa 118, 129, 185 

Jersey  City,  N.  J 177 

Johns  Hopkins  Hospital 118, 128 

Johns  Hopkins  Medical  School 107, 108, 109 

Johns  Hopkins  University,  Baltimore,   Md__-'__  129,136,158,159,184,185,189 

Johns  Hopkins  University,  Psychological  Laboratory 152 

Johnson,  J.  R 126 

Journal,  American  Chemical  Society 119, 121 

Journal,  American  Medical  Association 109, 114 

Junction  City,  Kans 177 

Kalamazoo,  Mich 99, 175 

Fairmount  Hospital 99, 157 

Kansas 48,  56,  57,  97, 157, 179, 190,  218 

Kansas  City,  Mo 179 

Kansas  State  Industrial  Farm  for  Women,  Topeka 175 

Kentucky 48,  56,  57,  97, 186, 157, 174, 179, 190,  218 

University  of,  Lexington 136,158 

Keokuk,  Iowa 98 

Key  West,  Fla . 96 

Kinsella,  Dr.  R.  A 111 

Kinston,  N.  C 98 

Knudson,  Dr.  Arthur 123 

Kucera,  F.  J 112 

Lake  County  General  Hospital,  Waukegan,  111 175 

Lancaster,  Pa 179 

Larson,  Dr.  W.  P 111 

Lashley,  Dr.  K.  S 152 

Law  creating  the  board,  background  of  and  purpose 160' 

Law    enforcement 172, 17S 

Law-enforcing  agencies,  relation  of  the  Interdepartmental  Social  Hygiene 

Board   to 44,  45 

Law-enforcement  division 163, 172, 173 

Law  enforcement,  public  health . 105 


262  INDEX. 

Page. 
Law-enforcement  section,  direction  of 21 

Stimulated  by  representatives 96 

Law  under  which  the  Interdepartmental  Social  Hygiene  Board  operates-  167, 197 
Lawton,  Okla 177 

Detention  home  and  hospital 175 

Lebanon,  Pa 98 

Lectures,  value  in  colleges 148 

Lee,  M.  M 123 

Leland  Stanford  University 129, 185 

Leland  Stanford,  Junior,  University  Medical  School 108, 116, 117, 159 

Levaditi   method 116, 123 

Lewis,  Dr.  W.  Lee 126 

Little  Rock,  Ark ^^ 177-179 

Literature 154 

Preparation  of  new ■ 154 

Loevenhart,  Dr.  A  S 119, 126, 127 

Lorenz,  Dr.  W.  F 119 

Louisiana 48,  58,  97,  99, 157, 177, 179, 190,  218 

State  Normal  School,  Natchitoches 158 

Louisville,  Ky: 

Jefferson  County  institutions 1 157 

Lovett,  R.  H 171 

Lowell,  Mass 177 

Lowry,  C.  D -' 126 

Lynn,  Mass 177 

McAdoo,  WilUam  G 2, 166,  217 

McArthur,  C.  A 117 

McClendon,  Dr.  J.  F 111 

McCormick,  John,  Institute  for  Infectious  Diseases 114, 159, 128, 129 

McFadden,   John  H.,  Research  Laboratory,  Jefferson  Medical  College, 

Philadelphia,  Pa 128 

McKay,  Dr.  WiUiam 117 

McNarama,  Dr.  Frank  P 123 

Maine 49,  59,  97,  157,  179,  190,  218 

Maintenance  of  venereal  disease  patients.     (See  Venereal  disease  patients, 
maintenance  of.) 

Manhattan,  Kans 177 

Mann  Act,  violation  of 89 

Manual  for  the  various  agents  of  the  Interdepartmental  Social  Hygiene 

Board 18,  footnote—      160 

Maryland 48,  59,  60,  97,  129,  157,  179,  190,  218 

Maryland  Normal  and  Industrial  School  (Colored),  BoAvie 135,158 

Maryland  State  Normal  School,  Towson,  Md . 158 

Mason  City,  Iowa 98 

Massachusetts 97,  129,  157,  179,  190,  195,  218 

Cost  of  venereal  diseases  in ; 193, 194 

Massachusetts  Reformatory  for  Women 172 

Massachusetts  State  Psychiatric  Institute,  Boston,  Mass 125, 

127, 129, 136, 158, 159 

Medical  examination,  individual,  Cornell 149 

Medical  measures,  report  on 100 

Meharg,  Virgil  E 127 

Mehrtens,  Dr.  H.  G 117 

Meine,  Dr.  Bertha  M . 125 


IKDEX.  263 

Page. 

Memphis,   Tenn 177 

Men  arrested,  number  of 22 

Men  involved  with  delinquent  women  and  girls 78,89 

Mercurochrorae  220 107, 109, 128 

Mercury 109,118 

Bichloride  of 112 

Meyer,  Dr.  Adolph 152 

Michigan 49,  61,  97, 129, 157, 174, 179, 190,  218 

College  of  Medicine  and  Surgery,  University  of  Michigan 116 

State  Normal  School,  Ypsilanti,  Mich 141, 147, 152, 188 

University  of  Michigan 116, 128, 129, 185 

Milwaukee  State  Normal  School,  Milwaukee,  Wis 159 

Miner,  O.   E ^ 171 

Minneapolis,    Minn ; 179 

Minnesota 49,  61,  97, 129, 157, 179, 190,218 

University  of,  Medical  School 111,  112, 122, 129, 159, 185 

Mission  Valley  Isolation  Hospital,  San  Diego,  Calif 175 

Mississippi 49,  61,  62,  97, 136, 157, 170, 190,  218 

Mississippi,  University  of 151, 158 

Missouri. 48,  62,  63,  97,  129,  157,  159,  179,  190,  218 

Baptist  Sanitarium  Hospital 120 

State  Teachers'   College,  Kirkville,   Mo 158 

University  of,  Columbia,  Mo 158 

Mobile,    Ala 177 

Monessen,  Pa 96 

Montana 49,  63,  158,  179,  190,  218 

Motzkau,  A _—      117 

Motion  picture  films.     (See  Films.) 

Mount  Holly,  N.  J .—      177 

Moyle,  Judge  J.  H 166 

Muscatine,  Iowa — —        98 

N-arsenetripiperidonium  chloride 120 

Nashville,  Tenn 98 

Natchez,  Miss 98 

National  security  and  defense  fund 169, 170, 172 

National  Training  School  for  Girls  in  District  of  Columbia 172 

Navy 161,164 

Complements 49 

Department 161 

Medical  Service  of 160 

Protection  from  venereal  disease 43 

Sources  of  infection 45 

Stations,  illustration  following  page  85 49 

Venereal  disease  in :__  11, 17, 23,  85,  95, 164 

Venereal  Infections  in  the 164 

Nebraska 49,  63, 158, 190,  218 

^  State  Medical  Journal 111 

University  of.  College  of  Medicine 110 

University  of 128, 129, 185 

Neighborhood  settlement  house 87 

Neoarsphenamine  (see  also  Arsphenamine ;  salvarsan) 118 

Neosalvarsan 120 

Neurosyphilis,  changes  produced  by  the  treatment  of 125 


264  INDEX. 

Page. 

Nevada _ 49,  63, 158, 190,  218 

University  of,  Reno,  Nev 158 

Newark,  N.  J 179 

Newburgh,  N.  Y . 177 

New  Brunswick,  N.  J 177 

New    Hampshire 48,  64,  97, 179, 190,  218 

New  Jersey ■ 179, 190 

New  London,  Conn 179 

New  Mexico 49,  65,  97, 158, 179, 190,  218 

University  of  Albuquei-que,  N.  Mex 158 

New  Orleans,  La 177, 179 

Newport  News,  Va 177, 179 

New  York ' 49,  65,  66,  97, 158, 179, 190,  218 

City 177, 179 

College  of  the  City  of.  New  York 158 

State  Board  of  Health  venereal  disease  prevention  exhibit 148 

State  Teachers'  College,  Albany,  N.  Y 147, 148, 150, 158, 159 

University 129 

University  and  Bellevue  Hospital  Medical  College 115 

Niagara  Falls,  N.  Y 96 

Nixon,  Dr.  C.  E 122 

Noble,    Dr 115 

Norfolk,  Va 177 

Norfolk,  Va.,  City  Hospital  and  City  Home 99, 157 

Normal  School.     ( See  Educational  research  and  development. ) 

North    Carolina 48,  67,  97, 158, 174, 179, 190,  218 

College  for  Women,  Greensboro,  N.  C 159 

North  Dakota 49,  67, 158, 190,  218 

Normal   school 147 

Northern  Normal  and  Industrial  School,  Aberdeen,  S.  Dak 159 

Northern  Illinois  State  Normal  School,  Dekalb,  111 158 

Northwestern  University,  Evanston,  111 126, 127, 158 

Ohio 49,  67,  68,  97, 158, 179, 190,  218 

Oklahoma 49,  69,  97, 158, 179, 190,  218 

Old  Forge,  Pa 98 

Ordway,  Dr.  Thomas 123 

Oregon 49,  69,  97, 158, 190,  218 

University  of,  Eugene , 159 

Organization,  period  of 166 

Oswego,  N.  Y.,  State  Normal  and  Training  School 141, 158 

Ottumwa,   Iowa ; 98 

Outline  and  syllabus  on  hygiene 136 

Palmer,  C.  S 126 

Pamphlets  printed  in  Italian,  Spanish,  and  Yiddish 155 

Parent  teachers'  associations 151 

Park,  Dr.  William  H 115 

Park  City,  Utah 86 

Patchogiie,  Long  Island 177 

Paterson,  N.  J 85,98 

Payment  to  States 162 

Payments  to  States  fund 19,  23,  28,  30,  98,  101,  105,  156,  174,  190 

Payments  to  universities.     {See  Educational  research  and  development 
fund.) 


INDEX.  265 

Page. 

Peabody  College  for  Teachers,  Nashville,  Tenn_l 159 

Pennsylvania 48,  69,  70,  71,  97,  157,  158,  174,  179,  190,  218 

University  of 141 

Pensacola,  Fla 98 

Peoria,  111 98 

Personnel  Section 35 

Petersburg,  Va 177,  179 

Phelps,  Lieut.  Commander  J.  R.,  Medical  Corps,  United  States  Navy 2, 166 

Philadelphia,  Pa 177 

Philippine    Islands 76 

Phipps  Psychiatric  Clinic,  Baltimore,  Md 152, 153 

Physical  education,  department  of  (see  also  Hygiene,  departments  of) 141 

Physical    training 143, 144, 145,  234,  240 

Activities  (see  also  Hygiene,  departments  of) 141 

Opportunities   in « 149 

Principals    of 233,  240 

Supervision   of,   Harvard 149 

Teachers  of 241 

Pierce,  C.  C,  Assistant  Surgeon  General 2, 166, 101  (footnote) 

Pine  Blulf  School,  Louisville,  Ky 175 

Pittsburgh,  Pa 177 

Population  of  Continental  United  States,  census  of  1910 218 

Port  Arthur,  Tex 98 

Porto    Rico , 77 

Portland,    Oreg 177 

Portsmouth,   N.   H 179 

Portsmouth,    Va 177 

Posters,  for  the  use  of  State  boards  of  health  and  educational  authorities-      155 

Pottsville,  Pa : 96 

President  of  the  United  States 169, 172 

Princeton,  N.  J I 177 

Principles  and  regulations,  educational  researches,  and  development  fund_      129 

Prostitutes 96,  97,  161 

Case  histories  of 85ff 

Case  vi^ork  with,  table 78 

Commitment   of 17 

Disseminator  of  venereal  diseases 12,  22 

Observed 22 

Rehabilitation  of 17,  47 

School  for 91 

Prostitutes.     {See  also  Delinquent  women  and  girls.) 

Prostitution 21,  22,  23,  25,  91, 173 

Control  of —  12, 47 

Houses  of 16,  21,  22,  45, 92,  96,  97 

Programs  of 96 

Programs  and  machineries  of 16,21,22,45 

Sources  of 90 

Suppression  of,  clandestine  and  public 216 

Prostitution  in  New  York  City,  report  on 22 

Protection  of  soldiers  and  sailors  through  the  control  of  vice  and  venereal 

disease 177 

Protection  against  veneral  diseases.     (See  Veneral  diseases.) 

Protective  hygiene  program 161 


266  INDEX. 

Page. 

Protective  social   measures 2 16, 20,  21,  22,  42 

Program    of 85, 180,  203,  204 

Cities  and  towns  of  greater  military  and  naval  importance  in  which 
the  program  of  protective  social  measures  has  been  put  into  op- 
eration       49ff 

Program  of,  service  of  men  agents 179 

Program  of,  service  of  women  agents 175 

Protective  work  for  girls 176 

Pychological  research 19,  20,  24, 130, 131, 134 

Purpose   of 131 

Public-health  officer -— 215 

Public-health  lectures  in  educational  institutions 146 

Public  Health  Service 17, 137, 154,  l62, 164, 191 

Appropriation  for  the  establishment  of  a  Division  of  Veneral  Diseases 

in  the  United  States  Public  Health  Service 162 

Division  of  Veneral  Diseases  of  the  United   States  Public  Health 

Service 20, 23,  29,  38, 100, 163 

Division  of  Veneral  Diseases,  statement  summarizing  progress  made, 

etc 101 

Survey  of  clinics  made  by 103, 104 

Publications  of  the   United    States   Interdepartmental   Social   Hygiene 

Board  on  hand  June  30,  1920 — 248 

Puget  Sound,  Wash 177 

K-Hg-0-CO-R' 127 

Raleigh,  N.  C 98 

Reappropriations  for  the  year  ending  June  30,  1920 199 

Records  and  Planning,  division  of 241 

In  departments  of  hygiene 150 

In  educational  institutions 146 

Red  Cross 79 

Red-light  districts-r 16,  21,  22,  48,  85, 96,  98 

Relationship  to  the  Army  and  Navy 85 

Reduction  in  appropriation  for  1921 217 

Reed  College,  Portland,  Oreg 159, 189 

Reformatories 1'^'^ 

Assistance  to 19,  22,  99, 171, 172 

Regulations  for  assistance  of  institutions  in  the  maintenance  of  venereally 

infected  patients 98,  201 

For  the  establishment  of  divisions  of  educational  hygiene  in  State 

departments  of  health 245 

Governing  allotments  to  colleges 232,  235,  236 

Governing  educational  research  and  development 129,  232 

Governing  payments  of  allotments  for  departments  of  hygiene 235 

Governing  scientific-research  fund 229 

Reno,  Nev 98 

Research : 

Educational.      {See  Educational) 165 

Educational,  in  the  prevention  of  disease 137 

Psychological  (see  also  Sociological) 130,133,136,152 

Scientific.     {See  Scientific  research.) 

Sociological  (see  also  Psychological) 130,133,136,152 

Rhode  Island - 49,  71,  97, 158, 179, 190,  218 

Rigdon,  Dr.  R.  L 108 


INDEX.  267 

Page. 

Robinson,  Dr.  Elliot  B 113 

Rockford,    111 177 

Rosenberger,  Dr.  Randle  C 118, 119, 128 

Roundtree,  Dr.  L.  G 122 

Rules  and  Regulations : 

Governing  allotments  from  Payments  to  States  fund   {see  also  Ap- 
pendix  for) 20,  202 

Governing    Chamberlain    Kahn    Fund.     (Seel   Payments   to    States 

funds  ;  see  Appendix. ) 
Governing  educational  research  and  development  fund  {see  also  Ap- 
pendix for) 130 

Governing  expenditures  from  Payments  to  States 214 

Secretary  of  the  Treasury 215 

Scientific  Researches.     (See  Scientific  research  fund;  see  also  Ap- 
pendix for.) 

Russell,  Col.  F.  F 2 

St.  Louis,  Mo 177 

Female  detention  vp^ard 157, 175 

City  hospital 99-120 

Maternity  dispensary 120 

St.  Louis  Southwestern  R.  R.,  cost  of  venereal  diseases 193 

St.  Louis  University , 129 

St.  Louis  University  School  of  Medicine 111,159,185 

St.  Luke's  Hospital 120 

Saligenin,  sodium  salt  of  mercury 112 

Salisbury,   Md 153 

Salvarsan 118, 120, 127 

Saraarcand,   N.    S.,    State  Home   and   Industrial   School   for    Girls   and 

Women 99, 157, 175 

Sample  of  monthly  financial  report  from 238 

San  Antonio,  Tex 177 

San  Diego,  Calif 179 

San  Francisco,  Calif 99,177,179 

San  Francisco  Hospital 99,157,175 

Sanitary  supervisions 144 

Sanitary  surveys 233 

Savannah,  Ga 85-98 

Sawyer,  Maj.  W.  A 2 

Schmidt,  John  H 128 

Scientific    research 19, 107, 162, 163, 165, 170, 184 

Scientific  researches  :  Government  investments,  value  of 24 

Scientific  research  fund 16,  23,  28,  33, 136, 156, 183, 185.  229 

Appropriations  from 184, 185,  233 

Classification  of  and  description  of 107 

Data  on  scientific  research  fund 129 

Scranton,  Pa '. 98 

Seamen's  Institute,  New  York . 153 

Seattle,  Wash 177 

Secretary  of  the  Treasury 2,162,214 

Secretary  of  the  Navy 2,162,166,171,214,216 

Secretary  of  War 2, 162, 166, 171,  214,  216 

Section  II  of  Chapter  XV  of  the  Chamberlain-Kahn  Act 180 

Sections  5,  6,  and  7  of  Chapter  XV  of  the  Army  appropriation  bill 199 


268  INDEX. 

Page. 

Section  VII  of  the  act,  etc 198 

Section  VIII  of  tlie  act,  etc 198 

Section  13  of  the  act  of  Congress,  etc 172 

Section  on  reformatories  and  detention  houses,  Commission  on  Training- 
Camp  Activities 170 

Section    on    vice    and    liquor    control,    Commission    on    Training    Camp 

Activities 173,179 

Section  on  women  and  girls.  Commission  on  Training  Camp  Activities 173 

Segregated  districts.     {See  Red-light  districts.) 

Senate  committee 167 

Sex  life,  problems  of 234 

Sex  and  venei-eal  prevention,  instruction  in  hygiene  concerning 148 

Sex,  methods  of  presenting  to  high-school  students 148 

Sex  education 15, 152, 153 

Problems    in 153 

Shelby  jHospital,  Memphis,  Tenn 99,157 

Shepardson,  Mrs.  R.  T 117 

Sioux   City,   Iowa 98 

Smith,  Dr.  George  H 113 

Snavely,  Miss  Marion  E 113 

Snow,  Lieut.  Col.  W.  F.,  Medical  Corps,  United  States  Army 2, 166 

Social  hygiene,  instruction  by  lectures  not  sufficient 149 

Social  protective  agents 48 

Sociological -and  psychological  research  related  thereto 198 

Sociological  research 19,  20,  24, 130, 131, 134 

Purpose    of 131 

Solomon,  Dr.  H.  C 125 

Sources  of  infection,  named  in  Army  and  Navy  reports  {see  also  Venereal 

disease) 45 

South   Carolina 48,  71,  97, 158, 172, 174, 179, 190,  218 

University  of,  Columbia,  S.  C '.      159 

South  Dakota 190' 

Spalding,  Dr.  A.  S 48,71,108,158,218 

Spartanburg,   S.   C 177 

Spiroehseta  pallida  in  human  tissues,  a  research  for 115 

Springfield,  111 98 

Stafeord,  Douglas  D 115 

Starry,  Allen  C 116, 128 

State  commissioners  of  health,  cases  of  infection  reported  to 91 

State  councils  of  defense 176 

State  department  of  health 204 

State  divisions  of  hygiene 132 

State  health  departments,  cooperation  of 48 

States  in  which  plans  for  bureaus  have  not  yet  been  perfected 48 

States,  bureaus  of  protective  social  measures  in 48 

Statistical  study,  15,000  cases  of  delinquent  women  and  girls 14 

Statistics  of  cases,  Table  No.  1 : 

Texarkana  Hospital,  St.  Louis,  Southwestern  Ry  Lines 195 

Statistics,  protective  social  measures 22 

Stovall,  Dr.  W.  D 1 119 

Storey,  Dr.  T.  A 2,171 


INDEX.  269 

Page. 

Stroudsburg,  Pa 96 

Summary  of  the  work  of  the  board  for  period  ending  June  30,  1919 162 

Sundry  civil  bill 169,217 

Supervising  assistant 203,  204 

Surgeons  General  of  the  Army,  Navy,  and  United  States  Public  Health 

Service 197,  214, 215 

Surgeon  General  of  the  Army,  report  furnished  by 13 

Surgeon  General  of  the  Navy,  sources  of  infection  reported  to 91 

Surgeon  General,  Public  Health  Service 197,216 

Suspended  disbursements 236 

Swartz,  Dr.  E.  O 107,109 

Svvartz,  Ernest  O 128 

Syllabus,  outline  and  syllabus  on  hygiene.     (See  Hygiene.) 

Syphilis  {see  also  Venereal  disease) 92,  104,  115,  160,  161, 196,  199 

cases  of,  reported  to  State  board  of  health,  1919-20 102 

cerebrospinal 117 

A  study  of  hereditary 127 

Hereditary 120 

Methods    of  treating 116 

In  pregnant  women  and  new-born  children 122, 123 

New  organic  compounds  in  the  treatment  of 118 

In  the  rabbit,  a  study  of 121 

Of  the  central  nervous  system,  treatment  of 126 

Of  the    innocent 125 

.    Social  and  economic  effects  of 125 

Standardization  of  the  treatment  of .. 117 

Study  of  hereditary  transmission  of 120 

Treatment  of,  of  the  central  nervous  system 119 

As  a  venereal  disease 125 

Syphilitic,    the   latent 124 

An  investigation  on  the  family  of  the 136 

The  family  of 125 

Tables : 

Case  work — 

Table  1.  Number  of  cases 78 

Table  2.  Color  of  new  cases 78 

Table  3.  Men  involved 78 

Table  4.  Sex  I'elations  of  new  cases 78 

Table  5.  Source  of  complaint  of  new  cases ._ 79 

Table  6.  Reason  for  complaint  of  new  cases 80 

Table  7.  Di.sposition  of  new  cases 81 

Tables.  Disposition  of  continued  and  reopened  cases 82 

Table  9.  Total  disiwsition 83 

Table  10.  Special  data 84 

Statistics — 

Table  1.  Statistics  of  cases  from  free  venereal  service  at  Tex-   * 
arkana  Hospital  medical  department,  St.  Louis  Southwestern 

Railway  lines 195 

Table  2.  Cost   of   venereal    service   at   Texarkana   Hospital,    St. 
Louis  Southwestern  Railway  lines 196 


270  INDEX. 

Tabulations :  Fane. 

Showing   program    of  assignment   of   bureaus    of   protective   social 

measures 48 

Showing  location  of  Army  and  Navy  complements,  known  localities 
from  which  venereal  infections  have  been  received  by  soldiers,  and 
the  distribution  of  agents  of  the  board  for  the  application  of  pro- 
tective social  measures  as  of  June  30,  1920 49ff 

Showing  analysis  of  the  nine  consolidated  reports  of  individual 
venereal  disease  reports  Nos.  1  to  10,000,  submitted  in  compliance 
with   Surgeon   General's  Oifice  Circular  Letter  No.  293,  between 

September  10,  1919,  and  September  13,  1920 91 

Showing  red-light  districts  which  were  closed  through  the  assistance 
of  the  board's  field  representatives,  giving  number  of  houses  and 

inmates  thereof ^_        95 

Of  certain  observations  made  by  protective  social  agents  of  the 
board  in  their  search  for  the  foci  of  venereal  diseases  from  No- 
vember 1,  1919,  to  June  30,  1920 96 

Showing  red-light  districts  discovered  by  the  board's  agents  which 

remained  open  on  June  30,  1920 97 

Tabulation  showing  strength  of  the  Army  during  period  (calendar  year, 

1919)  covered  by  Col.  Chamberlain's  letter 194 

Tacoma,  Wash 85,  98, 177 

Tait,  Jean 123 

Tampa,  Fla 98 

Teague,  Dr.  O^car 108 

Tennessee 48, 71,  72,  97, 158, 179, 190,  2XS 

University  of,  Knoxville,  Tenn 159 

Texarkana,  Ark 195 

Texas 48,  71,  72,  97, 158, 179, 190, 195,  218 

Thing,  Miss  Alice 123 

Thompson,  Dr.  L.  J 125 

Tonopah,  Nev 98 

Torrey,  Dr.  John  C 112 

Travelers'  Aid  Society , 97,  98 

Treasury 198 

Treasury  Department 161 

Treatment,  prevention,  and  control  of  venereal  diseases 203 

Trenton,  N.  J 177 

Treponema  Pallidum  method  for  intervitam  staining 118 

Troy,  N.  Y 98 

Tuskegee  Normal  and  Industrial  Institute,  Tuskegee 135, 158 

Undercover  investigators,     (See  Confidential  protective  social  agents) 183 

Union    University 129 

Medical  department,  Albany  Medical  College 185 

Medical  School,  Albany,  N.  Y 121,123 

United   States   census ^ 214,  215 

United  States  Interdepartmental  Social  Hygiene  Board   (see  also  inter- 
departmental)   164, 166 

United  States  Public  Health  Service  (see  also  Public) 197,  215,  216,  217 

United  States  Public  Health  venereal  disease  fund  (see  also  payments  to 

States  '  fund 190 

Utah 49,  73,  97,  158,  179,  190,  218 

University  of  Utah,  Salt  Lake  City,  Utah 141,  151,  159 

Universities.     (See  educational  research  and  development.) 

Valley  City,  N.  Dak.,  State  Normal  School 159 


INDEX.  271 

Page. 

A''ancoiiver,   Wash__ 177 

Veeder,  Dr.  Borden  S 127 

Venereal  diseases  (see  also  Chancroid,  Gonorrhea,  and  Syphilis) 91, 

148, 161, 189, 195, 196,  215,  234 
Venereal   diseases : 

Bureau   of 215,  216 

Carriers  of   (see  also  Prostitute) 12,17,20,21,23,44,45 

Carriers,  causes  and  prevention 165 

Cases  reported  to  State  board  of  health 23 

Cases  of,  treated  at  clinics 23 

Cities  and  towns  in  which  infections  have  been  reported  by  soldiers--        49 

Clinics  for  the  treatment  of 17,  45,  81,  82,  83,  216 

Control,  organized  bureau  of 191 

Control,   outlook 18 

Control  of 14, 23,  25 

Cost  of 12,193 

Cost  of  treatment  in  clinics  per  capita 104 

Early   treatment   of 109 

Educational  nveasui-es  in  the  prevention  of 130,152 

Extent  of,  in  United  States 101 

Films  for _- 152 

Funds  for  the  use  of  boards  or  departments  of  health  in  the  preven- 
tion, control,  and  treatment  of 214 

Hospitals    {see  also  Hospitals) 86 

Hygiene  of  (see  Hygiene) 186 

Importance  of 241 

Incidence  of  in  the  United  States ^ ^      102 

In  the  Army 12,  24, 164 

Records  for  13  years 93 

Ten  thousand  cases  of 92 

In    the   civilian   population 11,23,24,91 

In  the  Navy 11,24,164, 

Informational  hygiene  of 154 

Instruction    in 130, 137, 142, 147,  233,  234 

Number  of  women  and  girls  examined  for 84 

Organized  plans  for  the  control  of 161 

Patients 175 

Maintenance  of 98, 157, 175 

Preliminary  reports  of  search  in  the  prevention  and  treatment  of —      128 

Prevalence  of 11 

Prevention  control,  and  treatment  of 130, 148,  214,  215,  217,  219,  220,  222 

Problems  in 130 

Program  of  the  Army 161 

Program  of  the  Navy 161 

Protection  of  soldiers  and  sailors  from 43 

Recognition  and  diagnosis  of  treponema  pallidum  in— 128 

Reporting  cases  of 102 

Reporting  of,  by  physicians 101 

Scientific  research  for  informational  hygiene  on   (see  also  Scientific 

research) 16 

Search  for  foci 97 

Sources  of  infection,  illustration 91 

Spread  of 215,  216 


272  ..  INDEX. 

Venereal  diseases — Continued.  Page. 

Study  of  organisms  of i 111 

Study  of  the  serology  and  pathology  of 122 

Treatment,  voluntary 81,  82,  83 

Treatment,  prevention  and  control  of 100 

Treponema   pallidum   in ^ 118 

"Venereal  infection  in  the  Army 164 

Venereal  prophylaxis  : 

Study  of  various  methods  of 108 

Use  in  the  Army •     108 

Vermont 49,  74,  97, 158, 179, 190,  218 

Vicksburg,    Miss 98 

Virginia  48,  74,  97, 1.58, 174, 179, 190,  218 

War  Camp  Community  Service , 176 

War  Department 161, 170, 171, 172 

Warthin,  Dr.  Aldred  Scott 116, 128 

Washington 48,  75,  97, 158, 190,  204,  218 

Washington,  D.  C 179 

Washington  University ; 129 

Washington  University  Dispensary ^^1       120 

Washington  University  School  of  Medicine.  St.  Louis,  Mo_  120, 124, 127, 159, 185 

Wassermann  tests,  number  made  in  1919  and  1920 103 

Wassermann  reaction,  studies  on  the  nature  of 123 

Watson,  Dr.  John  B 152, 153 

Waukegan,   111 179 

Weiss,  Dr.  R.  S 124 

West  Palm  Beach,  Fla 96,98 

West   Virginia 49,  75, 158, 179, 190,  218 

Wheeling,  W.  Va Jl 96 

White,  Dr.  Edwin  C 109,128 

Whitmore,  Dr.  Frank  C 127 

Whitney,  Dr.  William  R 122 

Wieber,  Miss  Ida 116 

Williams,  P.  S 117 

Wilmington,  Del 153, 177 

Wilson,    Miss 115 

Wilson,  N.   C 98 

Winona  Normal   School 148,158 

Winternitz,  Dr.  M.  C 123 

Wisconsin    49,  76,  97, 158, 159, 179, 190,  218 

University  of 126, 127, 128, 129, 1.59, 185 

University  of.  Medical  School 119 

Women's  Medical  College  of  Pennsylvania...  123, 129, 133, 135, 159, 184, 185, 188 

Woman  supervising  assistant  and  inspector 204 

Woodworth,  Dr.  Robert  S - 152 

Worcester,   Mass 179 

Wyoming 49,  76,  97, 158, 179, 190,  218 

Yale  University 129, 185 

Medical  School  of 113,123 

Young,  Dr.  Hugh  H 107, 108, 109, 118, 128 

Young  Women's  Christian  Association 79 

Younie,  John  C 123 

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